Healthcare Provider Details

I. General information

NPI: 1891090288
Provider Name (Legal Business Name): KSIAZEK MEDICAL SERVICES P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2011
Last Update Date: 12/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 S WADSWORTH BLVD
LAKEWOOD CO
80226-1513
US

IV. Provider business mailing address

65 S WADSWORTH BLVD
LAKEWOOD CO
80226-1513
US

V. Phone/Fax

Practice location:
  • Phone: 303-934-3600
  • Fax: 303-934-1559
Mailing address:
  • Phone: 303-934-3600
  • Fax: 303-934-1559

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: DR. KAREN KSIAZEK
Title or Position: PRESIDENT
Credential: MD
Phone: 303-934-3600