Provider Demographics
NPI:1417163536
Name:GRZEGOZEWSKI, MATTHEW CHARLES
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:CHARLES
Last Name:GRZEGOZEWSKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:MATTHEW
Other - Middle Name:C
Other - Last Name:GRZEGOZEWSKI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 173862
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80217-3862
Mailing Address - Country:US
Mailing Address - Phone:303-306-7783
Mailing Address - Fax:303-306-7753
Practice Address - Street 1:10101 RIDGEGATE PARKWAY
Practice Address - Street 2:
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-9810
Practice Address - Country:US
Practice Address - Phone:720-225-1900
Practice Address - Fax:303-306-7753
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2015-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD66242207P00000X
CODR.0052852207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
COP01250125OtherRAILROAD MEDICARE
CO99936383Medicaid
CO99936383Medicaid
CO302868YL2GMedicare PIN