Healthcare Provider Details

I. General information

NPI: 1194702084
Provider Name (Legal Business Name): INFECTIOUS DISEASE CONSULT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2005
Last Update Date: 10/30/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 E 19TH AVE STE 3700
DENVER CO
80218-1220
US

IV. Provider business mailing address

1601 E 19TH AVE STE 3700
DENVER CO
80218-1220
US

V. Phone/Fax

Practice location:
  • Phone: 303-831-4774
  • Fax: 303-839-7750
Mailing address:
  • Phone: 303-831-4774
  • Fax: 303-839-7750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RAYMOND N. BLUM
Title or Position: M.D.
Credential: M.D.
Phone: 303-831-4774