Healthcare Provider Details

I. General information

NPI: 1700498797
Provider Name (Legal Business Name): COLORADO SPORTS MEDICINE AND ORTHOPAEDICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2020
Last Update Date: 08/21/2020
Certification Date: 08/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 E 9TH AVE STE 420
DENVER CO
80220-3931
US

IV. Provider business mailing address

4071 S DAHLIA ST
CHERRY HILLS VILLAGE CO
80113-5145
US

V. Phone/Fax

Practice location:
  • Phone: 720-726-7995
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CATHERINE A LOGAN
Title or Position: ORTHOPAEDIC SURGEON
Credential: MD
Phone: 612-275-6924