Provider Demographics
NPI:1093780918
Name:C. KEITH FUJISAKI MD, PC
Entity Type:Organization
Organization Name:C. KEITH FUJISAKI MD, PC
Other - Org Name:SPORTS MEDICINE OF THE ROCKIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:FUJISAKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-403-7340
Mailing Address - Street 1:3455 LUTHERAN PKWY
Mailing Address - Street 2:SUITE 210
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-6017
Mailing Address - Country:US
Mailing Address - Phone:303-403-7340
Mailing Address - Fax:303-403-7347
Practice Address - Street 1:3455 LUTHERAN PKWY
Practice Address - Street 2:SUITE 210
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-6017
Practice Address - Country:US
Practice Address - Phone:303-403-7340
Practice Address - Fax:303-403-7347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-22
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO29370174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO4213838OtherAETNA
COP00049979OtherRAIL ROAD MEDICARE
CO104267500OtherFEDERAL WORKMAN'T COMP
CO20872771Medicaid
COFUA29319OtherBLUE CROSS BLUE SHIELD
CO104267500OtherFEDERAL WORKMAN'T COMP
CO=========002OtherROCKY MOUNTAIN HMO
COFUA29319OtherBLUE CROSS BLUE SHIELD
COC505728Medicare PIN