Healthcare Provider Details

I. General information

NPI: 1396323994
Provider Name (Legal Business Name): TRAVIS RYAN KOOIMA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2021
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 ROCKY MOUNTAIN AVE STE 2300
LOVELAND CO
80538-9004
US

IV. Provider business mailing address

2500 ROCKY MOUNTAIN AVE STE 2300
LOVELAND CO
80538-9004
US

V. Phone/Fax

Practice location:
  • Phone: 970-667-7664
  • Fax: 970-622-9843
Mailing address:
  • Phone: 970-667-7664
  • Fax: 970-622-9843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number81468
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberDR.0076748
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: