Provider Demographics
NPI:1003813999
Name:SWEENEY, TOD (MD)
Entity Type:Individual
Prefix:DR
First Name:TOD
Middle Name:
Last Name:SWEENEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6390 GARDENIA ST
Mailing Address - Street 2:SUITE 140
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80004-3535
Mailing Address - Country:US
Mailing Address - Phone:720-898-1110
Mailing Address - Fax:720-898-1113
Practice Address - Street 1:6390 GARDENIA ST
Practice Address - Street 2:SUITE 140
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80004-3535
Practice Address - Country:US
Practice Address - Phone:720-898-1110
Practice Address - Fax:720-898-1113
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO39385207Q00000X, 207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO50571737Medicaid
CO464488Medicare ID - Type Unspecified
COH60615Medicare UPIN