Healthcare Provider Details

I. General information

NPI: 1104118090
Provider Name (Legal Business Name): DANIEL R SARKO, MD, PROFESSIONAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2011
Last Update Date: 05/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4745 ARAPAHOE AVE STE 310
BOULDER CO
80303-1082
US

IV. Provider business mailing address

4745 ARAPAHOE AVE STE 310
BOULDER CO
80303-1082
US

V. Phone/Fax

Practice location:
  • Phone: 303-442-2913
  • Fax: 303-444-6198
Mailing address:
  • Phone: 303-442-2913
  • Fax: 303-444-6198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number49882
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DANIEL R SARKO
Title or Position: OWNER
Credential: MD
Phone: 303-442-2913