Healthcare Provider Details

I. General information

NPI: 1073558474
Provider Name (Legal Business Name): COLORADO DIAGNOSTIC MEDICINE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5920 S ESTES ST STE. 150
LITTLETON CO
80123-8618
US

IV. Provider business mailing address

4374 RELIABLE PARKWAY
CHICAGO IL
60686-0001
US

V. Phone/Fax

Practice location:
  • Phone: 303-948-5765
  • Fax: 303-948-5761
Mailing address:
  • Phone: 314-839-9901
  • Fax: 314-839-9902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License NumberNA
License Number StateCO

VIII. Authorized Official

Name: MR. SYED HAIDER
Title or Position: CEO
Credential:
Phone: 314-839-9901