Provider Demographics
NPI:1225004260
Name:CAMPANINI, RAFAEL S (MD)
Entity Type:Individual
Prefix:
First Name:RAFAEL
Middle Name:S
Last Name:CAMPANINI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 SHERMAN ST
Mailing Address - Street 2:STE 510
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80203-4400
Mailing Address - Country:US
Mailing Address - Phone:303-744-8644
Mailing Address - Fax:303-780-0787
Practice Address - Street 1:455 SHERMAN ST
Practice Address - Street 2:STE 510
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80203-4400
Practice Address - Country:US
Practice Address - Phone:303-744-8644
Practice Address - Fax:303-780-0787
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO38917207L00000X, 207LP3000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric Anesthesiology
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07501773Medicaid
NMF1746Medicaid
ND14730Medicaid
FL913210400Medicaid
KS100384310AMedicaid
SD7781590Medicaid
MT3500334Medicaid
WY115975500Medicaid
ID806664400Medicaid
NMF1746Medicaid
CO297066YKTGMedicare PIN
MT3500334Medicaid