Healthcare Provider Details

I. General information

NPI: 1114907482
Provider Name (Legal Business Name): DR. EDWARD K RACZKA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 07/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 E HARVARD AVE SUITE 385
DENVER CO
80210-5073
US

IV. Provider business mailing address

850 E HARVARD AVE SUITE 385
DENVER CO
80210-5073
US

V. Phone/Fax

Practice location:
  • Phone: 303-762-1200
  • Fax: 303-762-0508
Mailing address:
  • Phone: 303-762-1200
  • Fax: 303-762-0508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number298
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License Number298
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number298
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: