Organization
COLORADO SPRINGS NEPHROLOGY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT PROVENZANO MD (PRESIDENT)
(719) 237-6302
Entity
Organization
Contact information
Practice address
1725 E BOULDER ST, SUITE 105, COLORADO SPRINGS, CO 80909-5768
(866) 691-6243
Mailing address
45640 SCHOENHERR RD, SUITE B, SHELBY TOWNSHIP, MI 48315-6033
(866) 691-6243
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
—
—
Other
Enumeration date
10/27/2009
Last updated
08/26/2013
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