MEDICARE: CERES PHYSICIANS COLORADO PC

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	207VE0102X	Reproductive Endocrinology Physician

General Provider Information

NPI Number	:	1225909773
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CERES PHYSICIANS COLORADO PC

Provider Business Mailing Address
First Line	:	1 DANIEL BURNHAM CT STE 110C
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94109-0456
Country	:	US
Telephone Number	:	415-964-5618
Fax Number	:	415-964-5619

Provider Business Practice Location Address
First Line	:	1900 LAWRENCE ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80202-2946
Country	:	US
Telephone Number	:	415-964-5618
Fax Number	:	415-964-5619

Authorized Official
Title or Position	:	PARTNER
Name	:	PETER CHARLES KLATSKY
Credential	:	MD
Telephone Number	:	415-964-5618

Provider Enumeration Date	:	09/17/2025
Last Update Date	:	09/17/2025

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