MEDICARE: DR. BENJAMIN E KASSANOFF M.D.

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	J2121	TX
2	2085R0202X	Diagnostic Radiology Physician	MD17552	HI
3	2085R0202X	Diagnostic Radiology Physician	25137	NE
4	2085R0202X	Diagnostic Radiology Physician	04-36295	KS
5	2085R0202X	Diagnostic Radiology Physician	44004	CO
6	2085R0204X	Vascular & Interventional Radiology Physician	DR.0044004	CO

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1356345680
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BENJAMIN E KASSANOFF M.D.

Provider Business Mailing Address
First Line	:	10800 E GEDDES AVE STE 300
Second Line	:
City	:	ENGLEWOOD
State	:	CO
Zip	:	80112-3895
Country	:	US
Telephone Number	:	303-761-9190
Fax Number	:	720-874-4462

Provider Business Practice Location Address
First Line	:	501 E HAMPDEN AVE
Second Line	:
City	:	ENGLEWOOD
State	:	CO
Zip	:	80113-2702
Country	:	US
Telephone Number	:	303-761-9190
Fax Number	:	720-874-4462

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

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	03/29/2024

501 E HAMPDEN AVE , ATTN: STROKE CENTER
ENGLEWOOD, CO
80113-2702

Practice Phone: 303-788-5990
Practice Fax: 303-788-5043