1255795860 NPI number — CAITLIN GRESKOVICH HAYDEK M.D.

Table of content: CAITLIN GRESKOVICH HAYDEK M.D. (NPI 1255795860)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255795860 NPI number — CAITLIN GRESKOVICH HAYDEK M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAYDEK
Provider First Name:
CAITLIN
Provider Middle Name:
GRESKOVICH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255795860
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/22/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
COMMUNITY MEDICINE, PEDIATRICS
Provider Second Line Business Mailing Address:
777 BANNOCK ST, MC 1914
Provider Business Mailing Address City Name:
DENVER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80204
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-436-4949
Provider Business Mailing Address Fax Number:
303-436-5772

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
410 MARKET ST STE 400A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHAPEL HILL
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27516-4061
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
984-974-3900
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/09/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207N00000X , with the licence number: DR.0065482 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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