Healthcare Provider Details

I. General information

NPI: 1669652335
Provider Name (Legal Business Name): FREDRIC MICHAEL PIERACCI M.D., M.P.H.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2007
Last Update Date: 11/12/2021
Certification Date: 11/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 BANNOCK ST MC0206
DENVER CO
80204-4507
US

IV. Provider business mailing address

777 BANNOCK ST MC0206
DENVER CO
80204-4507
US

V. Phone/Fax

Practice location:
  • Phone: 303-436-4029
  • Fax: 303-436-6572
Mailing address:
  • Phone: 303-436-4029
  • Fax: 303-436-6572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number232755
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RB0002X
TaxonomyObesity Medicine (Internal Medicine) Physician
License Number48205
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number48205
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: