Provider Demographics
NPI:1548566383
Name:THEODORE S WIRECKI MD PC
Entity Type:Organization
Organization Name:THEODORE S WIRECKI MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:STANLEY
Authorized Official - Last Name:WIRECKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-618-2303
Mailing Address - Street 1:4770 E ILIFF AVE STE 226
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-6000
Mailing Address - Country:US
Mailing Address - Phone:303-618-2303
Mailing Address - Fax:303-757-7994
Practice Address - Street 1:4770 E ILIFF AVE STE 226
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-6000
Practice Address - Country:US
Practice Address - Phone:303-618-2303
Practice Address - Fax:303-757-7994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-26
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO208562084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty