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General NPI Number Information
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NPI Number | 1801087077
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Entity Type | Organization
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Legal Business Name | WOODLAND PARK SURGICAL ASSOCIATES, P.C.
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Dates
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Enumeration Date | 08/05/2007
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Last Update Date | 08/08/2008
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Provider Practice Location Address
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Address Line | 16222 HIGHWAY 24 SUITE 200
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City | WOODLAND PARK
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State | CO
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Zip | 80863
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Country | US
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Telephone | 719-686-2810
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Fax | 719-686-2809
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Provider Business Mailing Address
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Address Line | 16222 W. HWY 24 SUITE 200
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City | WOODLAND PARK
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State | CO
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Zip | 80863-0201
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Country | US
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Telephone | 719-686-2810
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Fax | 719-686-2809
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Authorized Official
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Title or Position | OWNER PHYSICIAN
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Name | RICHARD M MALYSZEK
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Credential | MD
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Telephone | 719-686-2810
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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 | DR-45687
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License Number State | CO
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