Provider Demographics
NPI:1558347591
Name:DOROTIK, NICOLE (MD)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:
Last Name:DOROTIK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:ZABAGLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1707 COLE BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401-3220
Mailing Address - Country:US
Mailing Address - Phone:303-716-8013
Mailing Address - Fax:303-763-5495
Practice Address - Street 1:7950 KIPLING ST
Practice Address - Street 2:SUITE 101
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80005-3923
Practice Address - Country:US
Practice Address - Phone:303-425-4680
Practice Address - Fax:303-425-1616
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO43883207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO98487221Medicaid
CTCO804506OtherMEDICARE
CO98487221Medicaid