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NPI Code Detail

MEDICARE: ABUNDANT HEALTHCARE, PLLC

MEDICARE: ABUNDANT HEALTHCARE, PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12081N0008XNeuromuscular Medicine (Physical Medicine & Rehabilitation) Physician43404CO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1COA106293OTHERCOGROUP PTAN

General Provider Information

NPI Number : 1023314234
Entity Type Code : Organization
Provider Name (Legal Business Name) : ABUNDANT HEALTHCARE, PLLC
Provider Business Mailing Address
First Line : 5630 N ACADEMY BLVD
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80918-3659
Country : US
Telephone Number : 719-630-0254
Fax Number : 719-630-0256
Provider Business Practice Location Address
First Line : 5630 N ACADEMY BLVD
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80918-3659
Country : US
Telephone Number : 719-630-0254
Fax Number : 719-630-0256
Authorized Official
Title or Position : VICE PRESIDENT
Name : KARL LARSEN
Credential : M.D.
Telephone Number : 719-630-0254
Provider Enumeration Date : 02/04/2011
Last Update Date : 06/08/2012

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Directions to “ABUNDANT HEALTHCARE, PLLC ” Practice Location

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