Provider Demographics
NPI:1104938208
Name:KOOY, TODD LANE (MD)
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:LANE
Last Name:KOOY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10800 E GEDDES AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80112-3895
Mailing Address - Country:US
Mailing Address - Phone:303-761-9190
Mailing Address - Fax:720-874-4462
Practice Address - Street 1:10800 E GEDDES AVE STE 300
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80112-3895
Practice Address - Country:US
Practice Address - Phone:303-761-9190
Practice Address - Fax:720-874-4462
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE265232085R0202X
KS04-363142085R0202X
CO506652085R0202X
HIMD175082085R0202X
WAMD000467212085R0204X
CODR.00506652085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY1104938208Medicaid
CO00978566Medicaid
KS200870140AMedicaid
MT1104938208Medicaid
KS200870140AMedicaid
CO00978566Medicaid
COCOA106645Medicare PIN
NENA1215075Medicare PIN
COP01132647Medicare PIN
COCOA106644Medicare PIN
COCOA106643Medicare PIN
COCOA106724Medicare PIN
NENA1214075Medicare PIN
KS111257021Medicare PIN
MT1104938208Medicaid
CO390970ZLJ3Medicare PIN