Provider Demographics
NPI:1568160604
Name:BRIAN P GRADISEK DPM PLLC
Entity Type:Organization
Organization Name:BRIAN P GRADISEK DPM PLLC
Other - Org Name:FOOT AND ANKLE CARE OF BOULDER COUNTY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:GRADISEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-449-2000
Mailing Address - Street 1:PO BOX 21150
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80308-4150
Mailing Address - Country:US
Mailing Address - Phone:303-449-2000
Mailing Address - Fax:303-449-9475
Practice Address - Street 1:6200 W 9TH ST UNIT 1B
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-4462
Practice Address - Country:US
Practice Address - Phone:303-449-2000
Practice Address - Fax:303-449-9475
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRIAN P GRADISEK DPM PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-02-17
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty