Provider Demographics
NPI:1164478236
Name:SIROKMAN, THOMAS G (CRNA)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:G
Last Name:SIROKMAN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1922 S XENIA CT
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-3331
Mailing Address - Country:US
Mailing Address - Phone:303-752-4541
Mailing Address - Fax:303-752-1588
Practice Address - Street 1:4600 S SYRACUSE ST
Practice Address - Street 2:STE 932
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80237-2750
Practice Address - Country:US
Practice Address - Phone:303-256-6467
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2009-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO60923163W00000X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO66980062Medicaid
CO66980062Medicaid