Provider Demographics
NPI:1225139645
Name:CENTENNIAL INTERNAL MEDICINE
Entity Type:Organization
Organization Name:CENTENNIAL INTERNAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:
Authorized Official - Last Name:KATZ
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:303-699-3197
Mailing Address - Street 1:14100 E ARAPAHOE RD
Mailing Address - Street 2:SUITE 340
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-4028
Mailing Address - Country:US
Mailing Address - Phone:303-699-3197
Mailing Address - Fax:303-699-3186
Practice Address - Street 1:14100 E ARAPAHOE RD
Practice Address - Street 2:SUITE 340
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-4028
Practice Address - Country:US
Practice Address - Phone:303-699-3197
Practice Address - Fax:303-699-3186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO23985207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COUPINMedicare UPIN
COC800440Medicare ID - Type UnspecifiedGROUP
COC800442Medicare ID - Type UnspecifiedINDIVIDUAL