Provider Demographics
NPI:1487282992
Name:NEUROLOGY INSTITUTE OF COLORADO, PLLC
Entity type:Organization
Organization Name:NEUROLOGY INSTITUTE OF COLORADO, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:K
Authorized Official - Last Name:GAZDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:830-896-8080
Mailing Address - Street 1:PO BOX 293879
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78029-3879
Mailing Address - Country:US
Mailing Address - Phone:830-896-8080
Mailing Address - Fax:
Practice Address - Street 1:433 SUMMIT BLVD UNIT 201
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80021-8299
Practice Address - Country:US
Practice Address - Phone:830-896-8080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-30
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical NeurophysiologyGroup - Single Specialty