Provider Demographics
NPI:1609977040
Name:GOLOSOW, NIKOLAS (MD)
Entity Type:Individual
Prefix:DR
First Name:NIKOLAS
Middle Name:
Last Name:GOLOSOW
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 1:3253 RED TREE PL
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-2716
Mailing Address - Country:US
Mailing Address - Phone:303-688-8080
Mailing Address - Fax:
Practice Address - Street 1:5500 S SYCAMORE ST
Practice Address - Street 2:SUITE 200
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-8201
Practice Address - Country:US
Practice Address - Phone:303-723-4296
Practice Address - Fax:303-996-1047
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO273982084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01273986Medicaid
CO01273986Medicaid
COC2029Medicare PIN
COE21606Medicare UPIN