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General NPI Number Information
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NPI Number | 1649705427
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Entity Type | Individual
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Provider Name | PAUL MICHAEL JUDISCAK D.O.
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Gender | Male
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Dates
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Enumeration Date | 04/28/2017
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Last Update Date | 07/21/2020
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Provider Practice Location Address
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Address Line | 7700 S BROADWAY
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City | LITTLETON
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State | CO
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Zip | 80122-2602
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Country | US
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Telephone | 303-730-8900
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Fax | 303-738-7755
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Provider Business Mailing Address
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Address Line | 10099 RIDGEGATE PKWY SUITE 120
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City | LONE TREE
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State | CO
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Zip | 80124-5531
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Country | US
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Telephone | 719-671-4054
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | TL.0006558
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | DR.0062246
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License Number State | CO
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