MEDICARE: EDWARD W CETARUK 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	207P00000X	Emergency Medicine Physician	34578	CO
2	207PT0002X	Medical Toxicology (Emergency Medicine) Physician	DR.0034578	CO

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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578533154
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDWARD W CETARUK MD

Provider Business Mailing Address
First Line	:	2555 S DOWNING ST
Second Line	:	SUITE 260
City	:	DENVER
State	:	CO
Zip	:	80210-5855
Country	:	US
Telephone Number	:	303-765-3800
Fax Number	:	303-765-3804

Provider Business Practice Location Address
First Line	:	2555 S DOWNING ST
Second Line	:	SUITE 260
City	:	DENVER
State	:	CO
Zip	:	80210-5855
Country	:	US
Telephone Number	:	303-765-3800
Fax Number	:	303-765-3804

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

Provider Enumeration Date	:	01/25/2006
Last Update Date	:	05/03/2016

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Directions to “ EDWARD W CETARUK MD” Practice Location

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