Healthcare Provider Details

I. General information

NPI: 1518108117
Provider Name (Legal Business Name): CHARLES T LIVSEY MD,PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2009
Last Update Date: 11/07/2024
Certification Date: 11/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

499 E HAMPDEN AVE SUITE 360
ENGLEWOOD CO
80113-2780
US

IV. Provider business mailing address

PO BOX 17528
DENVER CO
80217-0528
US

V. Phone/Fax

Practice location:
  • Phone: 303-781-4485
  • Fax:
Mailing address:
  • Phone: 405-682-3303
  • Fax: 405-384-6793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number046125
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number246643
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number48889
License Number StateCO
# 4
Primary TaxonomyY
Taxonomy Code2084E0001X
TaxonomyEpilepsy Physician
License Number12747246-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: