MEDICARE: D AMPEZZO NEUROLOGICA

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	204R00000X	Electrodiagnostic Medicine Physician

General Provider Information

NPI Number	:	1942744198
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	D AMPEZZO NEUROLOGICA

Provider Business Mailing Address
First Line	:	7207 STREAMSIDE DR
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-8816
Country	:	US
Telephone Number	:	970-315-4018
Fax Number	:	970-315-5554

Provider Business Practice Location Address
First Line	:	7207 STREAMSIDE DR
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-8816
Country	:	US
Telephone Number	:	970-315-4018
Fax Number	:	970-315-5554

Authorized Official
Title or Position	:	OWNER
Name	:	FERNANDO TECHY
Credential	:	M.D.
Telephone Number	:	970-315-4018

Provider Enumeration Date	:	12/07/2016
Last Update Date	:	12/07/2016

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