Healthcare Provider Details

I. General information

NPI: 1548412877
Provider Name (Legal Business Name): NMC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2008
Last Update Date: 10/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1685 S COLORADO BLVD SUITE 318
DENVER CO
80222-4000
US

IV. Provider business mailing address

1685 S COLORADO BLVD SUITE 318
DENVER CO
80222-4000
US

V. Phone/Fax

Practice location:
  • Phone: 303-991-8133
  • Fax:
Mailing address:
  • Phone: 303-991-8133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number41492
License Number StateCO

VIII. Authorized Official

Name: MR. GARY GHISELLI
Title or Position: MANAGER
Credential: MD
Phone: 303-991-8133