MEDICARE: COLORADO SPORTS MEDICINE AND ORTHOPAEDICS

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	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician

General Provider Information

NPI Number	:	1700498797
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLORADO SPORTS MEDICINE AND ORTHOPAEDICS

Provider Business Mailing Address
First Line	:	4071 S DAHLIA ST
Second Line	:
City	:	CHERRY HILLS VILLAGE
State	:	CO
Zip	:	80113-5145
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4500 E 9TH AVE STE 420
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80220-3931
Country	:	US
Telephone Number	:	720-726-7995
Fax Number	:

Authorized Official
Title or Position	:	ORTHOPAEDIC SURGEON
Name	:	DR. CATHERINE A LOGAN
Credential	:	MD
Telephone Number	:	612-275-6924

Provider Enumeration Date	:	08/20/2020
Last Update Date	:	08/21/2020

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Directions to “COLORADO SPORTS MEDICINE AND ORTHOPAEDICS ” Practice Location

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