Healthcare Provider Details

I. General information

NPI: 1194787150
Provider Name (Legal Business Name): KIRK GEORGE BOUZARELOS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9094 E MINERAL CIR SUITE 120
CENTENNIAL CO
80112-7200
US

IV. Provider business mailing address

9094 E MINERAL CIR SUITE 120
CENTENNIAL CO
80112-7200
US

V. Phone/Fax

Practice location:
  • Phone: 303-779-5437
  • Fax: 303-689-9628
Mailing address:
  • Phone: 303-779-5437
  • Fax: 303-689-9628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number37233
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: