Provider Demographics
NPI:1194702084
Name:INFECTIOUS DISEASE CONSULT
Entity type:Organization
Organization Name:INFECTIOUS DISEASE CONSULT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:N
Authorized Official - Last Name:BLUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-831-4774
Mailing Address - Street 1:1601 E 19TH AVE STE 3700
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-1220
Mailing Address - Country:US
Mailing Address - Phone:303-831-4774
Mailing Address - Fax:303-839-7750
Practice Address - Street 1:1601 E 19TH AVE STE 3700
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1220
Practice Address - Country:US
Practice Address - Phone:303-831-4774
Practice Address - Fax:303-839-7750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-30
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01263235Medicaid
CO26323OtherLICENSE
COC52044Medicare PIN
CO01263235Medicaid