1497754022 NPI number — DR. JOSEPH W MASLAK M.D.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497754022 NPI number — DR. JOSEPH W MASLAK M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MASLAK
Provider First Name:
JOSEPH
Provider Middle Name:
W
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1497754022
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/24/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
03/18/2006
NPI Reactivation Date:
03/28/2006

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 17503
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DENVER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80217-0503
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-306-7783
Provider Business Mailing Address Fax Number:
303-306-7753

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16420 W US HIGHWAY 24
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WOODLAND PARK
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80863-8760
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-365-1292
Provider Business Practice Location Address Fax Number:
719-365-6997
Provider Enumeration Date:
07/15/2005

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: 207R00000X , with the licence number:  036100484 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: DR.0052135 , 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)

  • Identifier: 0361004841 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 98630059 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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