MEDICARE: BOULDER EKG

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	207R00000X	Internal Medicine Physician
2	207RC0000X	Cardiovascular Disease Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	CD4754	OTHER	CO	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	BOR7208	OTHER	CO	BLUE SHIELD

General Provider Information

NPI Number	:	1174581433
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOULDER EKG

Provider Business Mailing Address
First Line	:	1100 BALSAM AVE
Second Line	:
City	:	BOULDER
State	:	CO
Zip	:	80304-3404
Country	:	US
Telephone Number	:	303-440-3083
Fax Number	:

Provider Business Practice Location Address
First Line	:	3464 S WILLOW ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80231-4531
Country	:	US
Telephone Number	:	303-755-2900
Fax Number	:	303-755-0404

Authorized Official
Title or Position	:	MANAGING PARTNER
Name	:	ERIC ZACHARIAS
Credential	:	MD
Telephone Number	:	303-440-3083

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	10/29/2007

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Directions to “BOULDER EKG ” Practice Location

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