Healthcare Provider Details

I. General information

NPI: 1629829098
Provider Name (Legal Business Name): COLORADO ADVANCED ENDOVASCULAR, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2024
Last Update Date: 04/01/2024
Certification Date: 04/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 UNION BLVD STE 150
LAKEWOOD CO
80228-6516
US

IV. Provider business mailing address

7375 W 52ND AVE STE 210
ARVADA CO
80002-3748
US

V. Phone/Fax

Practice location:
  • Phone: 720-669-3036
  • Fax: 720-545-1584
Mailing address:
  • Phone: 303-223-4448
  • Fax: 720-501-5199

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: ASHLEY DORMAN
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 720-669-3036