Provider Demographics
NPI:1124011606
Name:GHISELLI, GARY (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:
Last Name:GHISELLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7800 E ORCHARD RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-2583
Mailing Address - Country:US
Mailing Address - Phone:303-783-1300
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
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0042446207X00000X, 207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO841519664006OtherRMHMO
COGH669216OtherBCBS
CO107033250101OtherIHC
4019320001OtherPALMETTO GBA
CO84151966413OtherPACIFICARE
COGH669216OtherBCBS
COH87784Medicare UPIN