Healthcare Provider Details

I. General information

NPI: 1639207095
Provider Name (Legal Business Name): DIVERSIFIED RADIOLOGY OF COLORADO, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 09/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 E 19TH AVE STE 3850
DENVER CO
80218-1216
US

IV. Provider business mailing address

938 BANNOCK ST STE 300
DENVER CO
80204-4028
US

V. Phone/Fax

Practice location:
  • Phone: 303-226-7225
  • Fax:
Mailing address:
  • Phone: 303-914-8800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER MCMILLAN
Title or Position: CEO
Credential:
Phone: 303-914-8800