Healthcare Provider Details

I. General information

NPI: 1689940280
Provider Name (Legal Business Name): ANDREW TADEUSZ BURZYNSKI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2012
Last Update Date: 07/08/2020
Certification Date: 07/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8300 W 38TH AVE
WHEAT RIDGE CO
80033-6005
US

IV. Provider business mailing address

PO BOX 668
ARVADA CO
80001-0668
US

V. Phone/Fax

Practice location:
  • Phone: 303-422-9438
  • Fax: 303-422-9474
Mailing address:
  • Phone: 303-422-9438
  • Fax: 303-422-9474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberDR0064610
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: