MEDICARE: COLORADO GASTROENTEROLOGY PROF LLC

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
1	207RG0100X	Gastroenterology Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	DB9573	OTHER	CO	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396790101
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLORADO GASTROENTEROLOGY PROF LLC

Provider Business Mailing Address
First Line	:	1960 N OGDEN ST STE 220
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80218-3668
Country	:	US
Telephone Number	:	303-861-0808
Fax Number	:	303-861-2193

Provider Business Practice Location Address
First Line	:	1960 N OGDEN ST STE 220
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80218-3668
Country	:	US
Telephone Number	:	303-861-0808
Fax Number	:	303-861-2193

Authorized Official
Title or Position	:	MANAGING PHYSICIAN
Name	:	DR. KEVIN S SIEJA
Credential	:	M.D.
Telephone Number	:	303-861-0808

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	04/21/2025

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