Healthcare Provider Details

I. General information

NPI: 1477683217
Provider Name (Legal Business Name): CHARLES E. KOFTAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: CHARLES E. KOFTAN MD

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 02/09/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

799 E HAMPDEN AVE 300
ENGLEWOOD CO
80113-2700
US

IV. Provider business mailing address

PO BOX 60
ENGLEWOOD CO
80151-0060
US

V. Phone/Fax

Practice location:
  • Phone: 303-493-5200
  • Fax: 720-570-2012
Mailing address:
  • Phone: 303-493-5200
  • Fax: 720-570-2012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberDR.0030663
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberDR.0030663
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: