MEDICARE: WARREN CHARLES STOPAK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1134700016
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WARREN CHARLES STOPAK

Provider Business Mailing Address
First Line	:	2230 HOLLY ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80207-3843
Country	:	US
Telephone Number	:	301-801-0813
Fax Number	:

Provider Business Practice Location Address
First Line	:	13120 E 19TH AVE
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80045-2567
Country	:	US
Telephone Number	:	301-801-0813
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/21/2021
Last Update Date	:	06/30/2024

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