Provider Demographics
NPI:1477683217
Name:KOFTAN, CHARLES E
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:E
Last Name:KOFTAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:CHARLES
Other - Middle Name:E
Other - Last Name:KOFTAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 60
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80151-0060
Mailing Address - Country:US
Mailing Address - Phone:303-493-5200
Mailing Address - Fax:720-570-2012
Practice Address - Street 1:799 E HAMPDEN AVE
Practice Address - Street 2:300
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-2700
Practice Address - Country:US
Practice Address - Phone:303-493-5200
Practice Address - Fax:720-570-2012
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0030663208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01306638Medicaid
016231OtherKAISER-COMMERCIAL NUMBER
016231OtherKAISER-COMMERCIAL NUMBER
CO416941YL2GMedicare PIN