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NPI Code Detail

MEDICARE: OPTUMCARE COLORADO MEDICAL GROUP LLC

MEDICARE: OPTUMCARE COLORADO MEDICAL GROUP 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
1207Q00000XFamily Medicine Physician

General Provider Information

NPI Number : 1992336283
Entity Type Code : Organization
Provider Name (Legal Business Name) : OPTUMCARE COLORADO MEDICAL GROUP LLC
Provider Business Mailing Address
First Line : 2 S CASCADE AVE STE 140
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80903-1604
Country : US
Telephone Number : 719-538-2900
Fax Number : 719-538-2996
Provider Business Practice Location Address
First Line : 6140 TUTT BLVD STE 200
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80923-3576
Country : US
Telephone Number : 719-380-6800
Fax Number : 719-380-6810
Authorized Official
Title or Position : MEDICAL DIRECTOR
Name : DAVID I COHEN
Credential :
Telephone Number : 702-480-2550
Provider Enumeration Date : 01/27/2020
Last Update Date : 03/07/2024

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Directions to “OPTUMCARE COLORADO MEDICAL GROUP LLC ” Practice Location

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