Healthcare Provider Details

I. General information

NPI: 1649775487
Provider Name (Legal Business Name): PATRIK SUWAK DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2018
Last Update Date: 06/19/2025
Certification Date: 06/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 E PROSPECT RD
FORT COLLINS CO
80525-9718
US

IV. Provider business mailing address

2500 E PROSPECT RD
FORT COLLINS CO
80525-9718
US

V. Phone/Fax

Practice location:
  • Phone: 970-493-0112
  • Fax: 970-493-0521
Mailing address:
  • Phone: 970-493-0112
  • Fax: 970-493-1794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number73609
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberDR.0072771
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: