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General NPI Number Information
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NPI Number | 1437132859
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Entity Type | Individual
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Provider Name | NICHOLAS ALFRED PIANTANIDA M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/21/2005
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Last Update Date | 02/11/2019
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Provider Practice Location Address
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Address Line | 175 S UNION BLVD STE 350
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City | COLORADO SPRINGS
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State | CO
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Zip | 80910-3146
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Country | US
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Telephone | 719-633-5515
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Fax | 719-365-1307
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Provider Business Mailing Address
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Address Line | 3027 N CIRCLE DR
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City | COLORADO SPRINGS
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State | CO
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Zip | 80909-1179
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Country | US
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Telephone | 719-776-4646
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Fax | 719-776-4640
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0050399
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | 200301159
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | 50399
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License Number State | CO
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