Healthcare Provider Details

I. General information

NPI: 1528220258
Provider Name (Legal Business Name): PETER M. BIANCO DO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2008
Last Update Date: 07/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5333 N UNION BLVD STE 200
COLORADO SPRINGS CO
80918-2051
US

IV. Provider business mailing address

5333 N UNION BLVD STE 200
COLORADO SPRINGS CO
80918-2051
US

V. Phone/Fax

Practice location:
  • Phone: 719-598-0500
  • Fax: 719-268-6834
Mailing address:
  • Phone: 719-598-0500
  • Fax: 719-268-6834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number27337
License Number StateCO

VIII. Authorized Official

Name: DR. PETER M BIANCO
Title or Position: OWNER
Credential: D.O
Phone: 719-598-0500