Provider Demographics
NPI:1619474822
Name:REZNICEK, EMILY ANNA (MD)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:ANNA
Last Name:REZNICEK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:ANNA
Other - Last Name:FRESE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:80 HEALTH PARK DR STE 100
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-4644
Mailing Address - Country:US
Mailing Address - Phone:303-673-0448
Mailing Address - Fax:
Practice Address - Street 1:80 HEALTH PARK DR STE 100
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-4644
Practice Address - Country:US
Practice Address - Phone:303-666-2710
Practice Address - Fax:303-673-0438
Is Sole Proprietor?:No
Enumeration Date:2018-04-12
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CODR.0064314207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program