Provider Demographics
NPI:1124202536
Name:CHARLES E. FRANKUM, JR, MD, PROFESSIONAL LLC
Entity Type:Organization
Organization Name:CHARLES E. FRANKUM, JR, MD, PROFESSIONAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:WANCIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-830-2004
Mailing Address - Street 1:1960 OGDEN ST
Mailing Address - Street 2:SUITE 530
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-3666
Mailing Address - Country:US
Mailing Address - Phone:303-830-2004
Mailing Address - Fax:303-318-2604
Practice Address - Street 1:1960 OGDEN ST
Practice Address - Street 2:SUITE 530
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-3666
Practice Address - Country:US
Practice Address - Phone:303-830-2004
Practice Address - Fax:303-318-2604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-20
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO39773208600000X, 208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO18838359Medicaid
CO18838359Medicaid