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NPI Code Detail

MEDICARE: COLORADO ENDOSURGERY INSTITUTE, P.C.

MEDICARE: COLORADO ENDOSURGERY INSTITUTE, P.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208600000XSurgery Physician44107CO

General Provider Information

NPI Number : 1356519391
Entity Type Code : Organization
Provider Name (Legal Business Name) : COLORADO ENDOSURGERY INSTITUTE, P.C.
Provider Business Mailing Address
First Line : 8390 E CRESCENT PKWY
Second Line : SUITE 100
City : GREENWOOD VILLAGE
State : CO
Zip : 80111-2811
Country : US
Telephone Number : 720-290-8772
Fax Number : 720-206-0806
Provider Business Practice Location Address
First Line : 16830 NORTHGATE DR
Second Line : SUITE 130
City : PARKER
State : CO
Zip : 80134-5778
Country : US
Telephone Number : 720-290-8772
Fax Number : 720-206-0806
Authorized Official
Title or Position : CEO AND PRESIDENT
Name : DR. KEVIN DOUGLAS FRADKIN
Credential : M.D.
Telephone Number : 720-290-8772
Provider Enumeration Date : 02/12/2008
Last Update Date : 11/14/2008

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Directions to “COLORADO ENDOSURGERY INSTITUTE, P.C. ” Practice Location

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