Provider Demographics
NPI:1528044781
Name:DANGLEIS, KEITH (MD)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:
Last Name:DANGLEIS
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 1:10800 E GEDDES AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80112-3895
Mailing Address - Country:US
Mailing Address - Phone:303-761-9190
Mailing Address - Fax:720-874-4462
Practice Address - Street 1:501 E HAMPDEN AVE
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-2702
Practice Address - Country:US
Practice Address - Phone:303-761-9190
Practice Address - Fax:720-874-4462
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE250072085R0202X
KS04-362292085R0202X
HIMD175422085R0202X
CO385132085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104686060Medicaid
MO1528044781Medicaid
AKMD366COMedicaid
NM68229828Medicaid
IA1528044781Medicaid
TX1528044781Medicaid
NY02300172Medicaid
ME1528044781Medicaid
AZ175662Medicaid
KS200418390AMedicaid
CO36952885Medicaid
WI99111975Medicaid
WY117325100Medicaid
SD1528044781/7726670Medicaid
NE84-059792913Medicaid
OH0062338Medicaid
UT1528044781Medicaid
NE10025709000Medicaid
IL1528044781Medicaid
CA1528044781Medicaid
OK200236530AMedicaid
MI1528044781Medicaid
IL1528044781Medicaid
KSKA3249064Medicare PIN
COC22684Medicare PIN
CO300113542Medicare PIN
OK200236530AMedicaid
CO300113539Medicare PIN
AZ175662Medicaid
OH0062338Medicaid
WI99111975Medicaid
COH17657Medicare UPIN
SD1528044781/7726670Medicaid
TX1528044781Medicaid
NE84-059792913Medicaid
COC211928Medicare PIN