Provider Demographics
NPI:1043947807
Name:GAZAREK, RUDOLPH MICHAEL
Entity Type:Individual
Prefix:
First Name:RUDOLPH
Middle Name:MICHAEL
Last Name:GAZAREK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:RJ
Other - Middle Name:
Other - Last Name:GAZAREK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5900 PERTH ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80019-2230
Mailing Address - Country:US
Mailing Address - Phone:339-227-0825
Mailing Address - Fax:
Practice Address - Street 1:750 E 9TH AVE STE 208
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80203-3395
Practice Address - Country:US
Practice Address - Phone:720-295-0530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-02
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program