Healthcare Provider Details

I. General information

NPI: 1144806092
Provider Name (Legal Business Name): MARK ANDREW PRYSHLAK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2021
Last Update Date: 02/11/2025
Certification Date: 02/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1960 N OGDEN ST STE 460
DENVER CO
80218-3670
US

IV. Provider business mailing address

1960 N OGDEN ST STE 460
DENVER CO
80218-3670
US

V. Phone/Fax

Practice location:
  • Phone: 303-318-2500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0071094
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: