Healthcare Provider Details

I. General information

NPI: 1649210329
Provider Name (Legal Business Name): CAROLINE M GELLRICK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 09/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9830 I-70 FRONTAGE RD SOUTH
WHEAT RIDGE CO
80033
US

IV. Provider business mailing address

DEPT 557
DENVER CO
80291-0557
US

V. Phone/Fax

Practice location:
  • Phone: 303-467-4100
  • Fax: 303-420-0836
Mailing address:
  • Phone: 303-467-4155
  • Fax: 303-467-4156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number21414
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number21414
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number21414
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: