Healthcare Provider Details

I. General information

NPI: 1770107989
Provider Name (Legal Business Name): JOHN SOLAK MD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2020
Last Update Date: 09/20/2024
Certification Date: 09/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3524 AIRFIELD RD
FT CARSON CO
80913-4701
US

IV. Provider business mailing address

1650 COCHRANE CIR UNIT MEDDAC
FORT CARSON CO
80913-4604
US

V. Phone/Fax

Practice location:
  • Phone: 719-526-1910
  • Fax:
Mailing address:
  • Phone: 719-526-1910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number22077
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License Number22077
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: