MEDICARE: BRADLEY D VILIMS MD

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	207LP2900X	Pain Medicine (Anesthesiology) Physician	39054	CO
2	208VP0014X	Interventional Pain Medicine Physician	39054	CO

General Provider Information

NPI Number	:	1881664944
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRADLEY D VILIMS MD

Provider Business Mailing Address
First Line	:	3600 S YOSEMITE ST
Second Line	:	STE 330
City	:	DENVER
State	:	CO
Zip	:	80237-1812
Country	:	US
Telephone Number	:	303-268-4040
Fax Number	:	303-736-7147

Provider Business Practice Location Address
First Line	:	325 TELLER ST
Second Line	:	SUITE 240
City	:	LAKEWOOD
State	:	CO
Zip	:	80226-1606
Country	:	US
Telephone Number	:	303-268-4040
Fax Number	:	303-736-4147

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/23/2006
Last Update Date	:	10/03/2007

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