MEDICARE: CRYOGAM COLORADO, LLC

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	207VE0102X	Reproductive Endocrinology Physician		CO

General Provider Information

NPI Number	:	1477034502
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CRYOGAM COLORADO, LLC

Provider Business Mailing Address
First Line	:	2216 HOFFMAN DR STE B
Second Line	:
City	:	LOVELAND
State	:	CO
Zip	:	80538-4397
Country	:	US
Telephone Number	:	970-667-9901
Fax Number	:	970-461-7800

Provider Business Practice Location Address
First Line	:	2216 HOFFMAN DR STE B
Second Line	:
City	:	LOVELAND
State	:	CO
Zip	:	80538-4397
Country	:	US
Telephone Number	:	970-667-9901
Fax Number	:	970-461-7800

Authorized Official
Title or Position	:	DIRECTOR
Name	:	ELIZABETH CAIRO
Credential	:	PHD
Telephone Number	:	970-667-9901

Provider Enumeration Date	:	08/27/2018
Last Update Date	:	08/27/2018

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