Healthcare Provider Details

I. General information

NPI: 1528114105
Provider Name (Legal Business Name): TODD FREDERICK VANDERHEIDEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 07/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 BANNOCK ST MC 0188
DENVER CO
80204-4507
US

IV. Provider business mailing address

660 GOLDEN RIDGE RD STE 250
GOLDEN CO
80401-9541
US

V. Phone/Fax

Practice location:
  • Phone: 303-436-6000
  • Fax:
Mailing address:
  • Phone: 303-436-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number44248
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number44248
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: