Provider Demographics
NPI:1003015306
Name:WESTLAKE, LLC
Entity Type:Organization
Organization Name:WESTLAKE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:GHISELLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-888-7742
Mailing Address - Street 1:140 IVANHOE ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-5840
Mailing Address - Country:US
Mailing Address - Phone:303-888-7742
Mailing Address - Fax:303-783-1200
Practice Address - Street 1:7800 E ORCHARD RD
Practice Address - Street 2:SUITE 100
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-2583
Practice Address - Country:US
Practice Address - Phone:303-783-1300
Practice Address - Fax:303-783-1200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-16
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2415363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty