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General NPI Number Information
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NPI Number | 1336101765
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Entity Type | Organization
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Legal Business Name | COLORADO SPRINGS ENDOCRINE CLINIC PC
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Dates
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Enumeration Date | 04/03/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 325 E FONTANERO ST COLORADO SPRINGS ENDOCRINE CLINIC PC
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City | COLORADO SPRINGS
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State | CO
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Zip | 80907-7533
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Country | US
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Telephone | 719-636-3829
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Fax | 719-633-8571
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Provider Business Mailing Address
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Address Line | 325 E FONTANERO ST COLORADO SPRINGS ENDOCRINE CLINIC PC
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City | COLORADO SPRINGS
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State | CO
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Zip | 80907-7533
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Country | US
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Telephone | 719-636-3829
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Fax | 719-633-8571
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Authorized Official
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Title or Position | CORPORATE PRESIDENT
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Name | SUSAN E HENLEY
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Credential | MD
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Telephone | 719-636-3829
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number |
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License Number State |
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