Provider Demographics
NPI:1598051534
Name:KANIK, JOSHUA WILLIAM (MD)
Entity Type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:WILLIAM
Last Name:KANIK
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 1:501 AIRPORT RD FL 2
Mailing Address - Street 2:
Mailing Address - City:RIFLE
Mailing Address - State:CO
Mailing Address - Zip Code:81650-8510
Mailing Address - Country:US
Mailing Address - Phone:970-625-1100
Mailing Address - Fax:970-625-2752
Practice Address - Street 1:501 AIRPORT RD FL 2
Practice Address - Street 2:
Practice Address - City:RIFLE
Practice Address - State:CO
Practice Address - Zip Code:81650
Practice Address - Country:US
Practice Address - Phone:970-625-1100
Practice Address - Fax:970-625-2752
Is Sole Proprietor?:No
Enumeration Date:2011-06-28
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA41287207Q00000X
CODR.0065169207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine