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General NPI Number Information
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NPI Number | 1902878291
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Entity Type | Individual
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Provider Name | KENNETH GERALD OLESZEK MD
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Gender | Male
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Dates
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Enumeration Date | 02/02/2006
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Last Update Date | 06/07/2016
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Provider Practice Location Address
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Address Line | 2774 E 2ND AVE
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City | DENVER
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State | CO
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Zip | 80206-4808
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Country | US
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Telephone | 303-355-4772
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Fax |
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Provider Business Mailing Address
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Address Line | 2774 E 2ND AVE
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City | DENVER
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State | CO
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Zip | 80206-4808
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Country | US
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Telephone | 303-355-4772
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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 | 32815
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 202K00000X
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Taxonomy Name | Phlebology Physician
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License Number | 32815
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License Number State | CO
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