Provider Demographics
NPI:1316055981
Name:COLORADO NEURODIAGNOSTICS LLC
Entity type:Organization
Organization Name:COLORADO NEURODIAGNOSTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MIHAELA
Authorized Official - Middle Name:G
Authorized Official - Last Name:ALEXANDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-907-4239
Mailing Address - Street 1:PO BOX 131
Mailing Address - Street 2:
Mailing Address - City:BENNETT
Mailing Address - State:CO
Mailing Address - Zip Code:80102-0131
Mailing Address - Country:US
Mailing Address - Phone:303-644-5015
Mailing Address - Fax:
Practice Address - Street 1:7188 S MAGNOLIA CIR
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-6044
Practice Address - Country:US
Practice Address - Phone:303-907-4239
Practice Address - Fax:303-644-5015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO41898246ZE0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZE0500XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherEEGGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO41898OtherCOLORADO PHYSICIAN LICENS