Provider Demographics
NPI:1518139591
Name:CATANZANO, ATTILIO BRUCE (MD)
Entity Type:Individual
Prefix:
First Name:ATTILIO
Middle Name:BRUCE
Last Name:CATANZANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 151029
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80215-9029
Mailing Address - Country:US
Mailing Address - Phone:303-986-9504
Mailing Address - Fax:303-980-8431
Practice Address - Street 1:255 CANYON BLVD
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-4979
Practice Address - Country:US
Practice Address - Phone:303-449-7541
Practice Address - Fax:303-449-8973
Is Sole Proprietor?:No
Enumeration Date:2008-03-30
Last Update Date:2008-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO215112084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04141040Medicaid
COC14114Medicare PIN
CO04141040Medicaid