Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | DR.0055565 | CO |
N | 208000000X | Pediatrician | 4301098010 | MI |
N | 208000000X | Pediatrician | ML20008947 | WA |
N | 2080P0202X | Pediatric Cardiologist | 4301098010 | MI |
NPI | 1164622577 |
---|---|
Provider Name | Johannes Constantin Von Alvensleben |
First Address | Aurora, CO 80042-0429 |
Second Address | Aurora, CO 80045-7106 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2007 |
Last Update Date | 17/11/2018 |