Provider Demographics
NPI:1386640373
Name:KSIAZEK, KAREN LEE (MD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:LEE
Last Name:KSIAZEK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:
Other - Last Name:KSIAZEK-WILSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8333 RALSTON RD STE 1
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80002-2355
Mailing Address - Country:US
Mailing Address - Phone:720-295-8127
Mailing Address - Fax:303-423-1062
Practice Address - Street 1:1687 COLE BLVD STE 103
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80401-3318
Practice Address - Country:US
Practice Address - Phone:303-403-6688
Practice Address - Fax:303-403-6245
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO30621208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01306216Medicaid
2254Medicare ID - Type Unspecified
F60446Medicare UPIN