Healthcare Provider Details

I. General information

NPI: 1235833963
Provider Name (Legal Business Name): MODERN UROLOGY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2023
Last Update Date: 03/20/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4943 STATE HIGHWAY 52 STE 180
DACONO CO
80514-9106
US

IV. Provider business mailing address

4943 STATE HIGHWAY 52 STE 180
DACONO CO
80514-9106
US

V. Phone/Fax

Practice location:
  • Phone: 303-558-4995
  • Fax: 303-345-6005
Mailing address:
  • Phone: 303-558-4995
  • Fax: 303-345-6005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State

VIII. Authorized Official

Name: CAROLYN M FRONCZAK
Title or Position: PHYSICIAN OWNER
Credential: MD
Phone: 303-558-4995