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General NPI Number Information
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NPI Number | 1720285695
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Entity Type | Organization
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Legal Business Name | KENNETH D DANYLCHUK, MD, PC
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Dates
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Enumeration Date | 07/02/2007
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Last Update Date | 11/11/2010
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Provider Practice Location Address
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Address Line | 3530 SPAULDING AVE
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City | PUEBLO
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State | CO
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Zip | 81008-2209
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Country | US
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Telephone | 719-296-9000
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Fax | 719-296-9001
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Provider Business Mailing Address
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Address Line | 3530 SPAULDING AVE
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City | PUEBLO
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State | CO
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Zip | 81008-2209
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Country | US
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Telephone | 719-296-9000
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Fax | 719-296-9001
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. SHANA D STOLLSTEIMER
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Credential |
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Telephone | 719-296-9000
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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 | 29760
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License Number State | CO
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