Healthcare Provider Details

I. General information

NPI: 1972618510
Provider Name (Legal Business Name): ELLICE KAY GOLDBERG DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 03/03/2025
Certification Date: 03/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8101 E LOWRY BLVD STE 255
DENVER CO
80230-7121
US

IV. Provider business mailing address

8101 E LOWRY BLVD STE 255
DENVER CO
80230-7121
US

V. Phone/Fax

Practice location:
  • Phone: 720-321-3581
  • Fax: 720-321-3582
Mailing address:
  • Phone: 720-321-3581
  • Fax: 720-321-3582

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number27685
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number27685
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: