Healthcare Provider Details

I. General information

NPI: 1184899023
Provider Name (Legal Business Name): JILLIAN M CIOCCHETTI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JILLIAN M POLIS

II. Dates (important events)

Enumeration Date: 04/22/2008
Last Update Date: 05/27/2021
Certification Date: 05/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1960 N OGDEN ST STE 550
DENVER CO
80218-3676
US

IV. Provider business mailing address

1960 N OGDEN ST STE 550
DENVER CO
80218-3676
US

V. Phone/Fax

Practice location:
  • Phone: 303-812-6850
  • Fax: 303-812-6859
Mailing address:
  • Phone: 303-812-6850
  • Fax: 303-812-6859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number48354
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: