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General NPI Number Information
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NPI Number | 1770968372
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Entity Type | Individual
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Provider Name | THADDEUS EDWARD LINIEWICZ D.O.
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Gender | Male
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Dates
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Enumeration Date | 07/24/2015
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Last Update Date | 07/24/2015
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Provider Practice Location Address
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Address Line | 501 E HAMPDEN AVE #3245
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City | ENGLEWOOD
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State | CO
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Zip | 80113-2702
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Country | US
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Telephone | 303-788-8839
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Fax |
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Provider Business Mailing Address
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Address Line | 480 W BURGUNDY ST UNIT 1237
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City | HIGHLANDS RANCH
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State | CO
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Zip | 80129-6630
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Country | US
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Telephone | 847-814-3906
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | TL.0005469
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License Number State | CO
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