Healthcare Provider Details

I. General information

NPI: 1902984842
Provider Name (Legal Business Name): STEPHEN FAFINSKI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 09/14/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 E BOULDER ST
COLORADO SPRINGS CO
80909-5533
US

IV. Provider business mailing address

PO BOX 63300
COLORADO SPRINGS CO
80962-3300
US

V. Phone/Fax

Practice location:
  • Phone: 719-365-5853
  • Fax: 719-365-1048
Mailing address:
  • Phone: 719-578-1162
  • Fax: 719-578-1462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberDR.0055809
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: