Healthcare Provider Details

I. General information

NPI: 1982920237
Provider Name (Legal Business Name): MICHAEL BANZHAF CNIM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2010
Last Update Date: 04/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 OAKRIDGE DR SUITE 130
FORT COLLINS CO
80525-5564
US

IV. Provider business mailing address

1300 OAKRIDGE DR SUITE 130
FORT COLLINS CO
80525-5564
US

V. Phone/Fax

Practice location:
  • Phone: 877-377-9555
  • Fax:
Mailing address:
  • Phone: 877-377-9555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: