Provider Demographics
NPI:1508853243
Name:JANTZ, RICHARD D (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:D
Last Name:JANTZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4900 S MONACO ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-3486
Mailing Address - Country:US
Mailing Address - Phone:303-750-0822
Mailing Address - Fax:303-750-1298
Practice Address - Street 1:1444 S POTOMAC ST
Practice Address - Street 2:SUITE 300
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-4508
Practice Address - Country:US
Practice Address - Phone:303-750-0822
Practice Address - Fax:303-750-1298
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO23025207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100171250DMedicaid
CO01230259Medicaid
NE10026280600Medicaid
NE10026283100Medicaid
NE10026281200Medicaid
WY1508853243Medicaid
NE10026280800Medicaid
NE10026281000Medicaid
NE10026280700Medicaid
NE1982948089Medicaid
NE1982948089Medicaid
NE10026280800Medicaid
WY1508853243Medicaid
CO01230259Medicaid
NENA2301003Medicare PIN