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General NPI Number Information
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NPI Number | 1053172551
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Entity Type | Organization
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Legal Business Name | INFINITE NEUROLOGY OF COLORADO PLLC
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Dates
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Enumeration Date | 01/22/2024
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Last Update Date | 01/22/2024
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Provider Practice Location Address
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Address Line | 155 BOARDWALK DR # 490
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City | FORT COLLINS
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State | CO
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Zip | 80525-3040
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Country | US
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Telephone | 512-885-0488
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 530247
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City | ST PETERSBURG
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State | FL
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Zip | 33747-0247
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Country | US
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Telephone | 512-885-0488
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. ADAM S DIDIO
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Credential | MD
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Telephone | 512-885-0488
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0301X
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Taxonomy Name | Brain Injury Medicine (Psychiatry & Neurology) Physician
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License Number |
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License Number State |
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