MEDICARE: DR. NICOLE DOROTIK MD

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	207Q00000X	Family Medicine Physician	43883	CO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	CO804506	OTHER	CT	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

General Provider Information

NPI Number	:	1558347591
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICOLE DOROTIK MD

Provider Business Mailing Address
First Line	:	1707 COLE BLVD
Second Line	:	SUITE 100
City	:	GOLDEN
State	:	CO
Zip	:	80401-3220
Country	:	US
Telephone Number	:	303-716-8013
Fax Number	:	303-763-5495

Provider Business Practice Location Address
First Line	:	7950 KIPLING ST
Second Line	:	SUITE 101
City	:	ARVADA
State	:	CO
Zip	:	80005-3923
Country	:	US
Telephone Number	:	303-425-4680
Fax Number	:	303-425-1616

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

Provider Enumeration Date	:	12/21/2005
Last Update Date	:	10/04/2013

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