Healthcare Provider Details

I. General information

NPI: 1134688229
Provider Name (Legal Business Name): CONSTANTINOS VRAKAS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2019
Last Update Date: 01/10/2024
Certification Date: 01/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10099 RIDGEGATE PKWY STE 200
LONE TREE CO
80124-5532
US

IV. Provider business mailing address

700 S POTOMAC WAY
AURORA CO
80012-3539
US

V. Phone/Fax

Practice location:
  • Phone: 720-225-1000
  • Fax:
Mailing address:
  • Phone: 303-695-2600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number81134
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberDR.0066625
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: