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General NPI Number Information
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NPI Number | 1093780918
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Entity Type | Organization
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Legal Business Name | C. KEITH FUJISAKI MD, PC
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Dates
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Enumeration Date | 02/22/2006
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Last Update Date | 10/26/2009
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Provider Practice Location Address
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Address Line | 3455 LUTHERAN PKWY SUITE 210
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City | WHEAT RIDGE
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State | CO
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Zip | 80033-6017
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Country | US
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Telephone | 303-403-7340
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Fax | 303-403-7347
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Provider Business Mailing Address
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Address Line | 3455 LUTHERAN PKWY SUITE 210
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City | WHEAT RIDGE
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State | CO
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Zip | 80033-6017
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Country | US
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Telephone | 303-403-7340
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Fax | 303-403-7347
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHARLES KEITH FUJISAKI
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Credential | M.D.
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Telephone | 303-403-7340
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 29370
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License Number State | CO
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