Healthcare Provider Details

I. General information

NPI: 1386640373
Provider Name (Legal Business Name): KAREN LEE KSIAZEK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAREN KSIAZEK-WILSON

II. Dates (important events)

Enumeration Date: 06/23/2005
Last Update Date: 08/29/2022
Certification Date: 08/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1687 COLE BLVD STE 103
LAKEWOOD CO
80401-3318
US

IV. Provider business mailing address

8333 RALSTON RD STE 1
ARVADA CO
80002-2355
US

V. Phone/Fax

Practice location:
  • Phone: 303-403-6688
  • Fax: 303-403-6245
Mailing address:
  • Phone: 720-295-8127
  • Fax: 303-423-1062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number30621
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: