Healthcare Provider Details

I. General information

NPI: 1356370191
Provider Name (Legal Business Name): MARK SARINOPOULOS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 10/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 W MIDWAY BLVD
BROOMFIELD CO
80020-2090
US

IV. Provider business mailing address

198 W SYCAMORE LN
LOUISVILLE CO
80027-2234
US

V. Phone/Fax

Practice location:
  • Phone: 303-466-1866
  • Fax: 303-466-4081
Mailing address:
  • Phone: 303-358-6329
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number38117
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number38117
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: