Provider Demographics
NPI:1114907482
Name:RACZKA, EDWARD K
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:K
Last Name:RACZKA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 E HARVARD AVE
Mailing Address - Street 2:SUITE 385
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-5073
Mailing Address - Country:US
Mailing Address - Phone:303-762-1200
Mailing Address - Fax:303-762-0508
Practice Address - Street 1:850 E HARVARD AVE
Practice Address - Street 2:SUITE 385
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-5073
Practice Address - Country:US
Practice Address - Phone:303-762-1200
Practice Address - Fax:303-762-0508
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-20
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO298213EP1101X, 213ES0000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01002989Medicaid
CO7047OtherBC/BS PROVIDER #
CO840716431OtherTIN
CO55653Medicare UPIN
CO1250060001Medicare NSC
CO01002989Medicaid