Healthcare Provider Details

I. General information

NPI: 1346418225
Provider Name (Legal Business Name): KATIE ROSE ELLERBROCK M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2008
Last Update Date: 02/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1719 E 19TH AVE 5C EAST
DENVER CO
80218-1235
US

IV. Provider business mailing address

336 GRANT ST APT 301
DENVER CO
80203-4066
US

V. Phone/Fax

Practice location:
  • Phone: 303-839-6741
  • Fax:
Mailing address:
  • Phone: 216-287-8892
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number2580
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: