MEDICARE: COLORADO LASER AND VEIN PC

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
1	2086S0129X	Vascular Surgery Physician	37416	CO

General Provider Information

NPI Number	:	1376552000
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLORADO LASER AND VEIN PC

Provider Business Mailing Address
First Line	:	8120 S HOLLY ST
Second Line	:	SUITE 111
City	:	CENTENNIAL
State	:	CO
Zip	:	80122-4005
Country	:	US
Telephone Number	:	303-741-4060
Fax Number	:	720-489-6047

Provider Business Practice Location Address
First Line	:	8120 S HOLLY ST
Second Line	:	SUITE 111
City	:	CENTENNIAL
State	:	CO
Zip	:	80122-4005
Country	:	US
Telephone Number	:	303-741-4060
Fax Number	:	720-489-6047

Authorized Official
Title or Position	:	OWNER
Name	:	DAVID SIROOSPOUR
Credential	:	M.D.
Telephone Number	:	303-741-4060

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	07/30/2013

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