Individual
ALIREZA ETEMADI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
100 HEALTH PARK DR, LOUISVILLE, CO 80027-9583
(303) 673-1000
Mailing address
100 HEALTH PARK DR, LOUISVILLE, CO 80027-9583
(303) 673-1000
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
51266
CO
207Q00000X
Family Medicine Physician
G67093
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G670930
BLUE SHIELD
CA
05
—
00G670930
—
CA
05
—
09250255
—
CO
01
—
G67093
STATE LICENSE #
CA
Enumeration date
05/24/2006
Last updated
11/23/2016
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