Healthcare Provider Details

I. General information

NPI: 1194273003
Provider Name (Legal Business Name): CADIRAMD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2016
Last Update Date: 09/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4785 TEJON ST STE, 300
DENVER CO
80211-1200
US

IV. Provider business mailing address

4785 TEJON ST STE, 300
DENVER CO
80211-1200
US

V. Phone/Fax

Practice location:
  • Phone: 720-477-0640
  • Fax: 720-381-2582
Mailing address:
  • Phone: 720-477-0640
  • Fax: 720-381-2582

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BEAU GERTZ
Title or Position: OWNER, PRESIDENT - SALES/OPERATIONS
Credential:
Phone: 720-477-0637