MEDICARE: JANNIE MARIA BOLOTNIKOV MD, MPH

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	0077058	CO

General Provider Information

NPI Number	:	1750039145
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANNIE MARIA BOLOTNIKOV MD, MPH

Provider Business Mailing Address
First Line	:	777 BANNOCK ST # MC0108
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80204-4597
Country	:	US
Telephone Number	:	303-602-5193
Fax Number	:

Provider Business Practice Location Address
First Line	:	777 BANNOCK ST # MC0108
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80204-4507
Country	:	US
Telephone Number	:	303-602-5193
Fax Number	:

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

Provider Enumeration Date	:	03/14/2022
Last Update Date	:	06/16/2026

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