Healthcare Provider Details

I. General information

NPI: 1346377322
Provider Name (Legal Business Name): PATRICK A KUSEK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 03/13/2021
Certification Date: 03/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11245 HURON ST
WESTMINSTER CO
80234-2806
US

IV. Provider business mailing address

11245 HURON ST
WESTMINSTER CO
80234-2806
US

V. Phone/Fax

Practice location:
  • Phone: 303-338-4545
  • Fax:
Mailing address:
  • Phone: 303-338-4545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number36100
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: