Healthcare Provider Details

I. General information

NPI: 1124024799
Provider Name (Legal Business Name): CREEKSIDE ENDOCRINE ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 02/18/2022
Certification Date: 02/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 E. LOUISIANA AVE STE 200
DENVER CO
80246-3431
US

IV. Provider business mailing address

4101 E. LOUISIANA AVE STE 200
DENVER CO
80246-3431
US

V. Phone/Fax

Practice location:
  • Phone: 303-388-6410
  • Fax: 303-388-1069
Mailing address:
  • Phone: 303-388-6410
  • Fax: 303-388-1069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number27647
License Number StateCO

VIII. Authorized Official

Name: LEONARD R. ZEMEL
Title or Position: OWNER - PHYSICIAN
Credential: M.D.
Phone: 303-388-6410