Provider Demographics
NPI:1619534575
Name:KLOBERDANZ, ANDREW GORDON (DO)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:GORDON
Last Name:KLOBERDANZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1805 SHEA CENTER DR STE 450
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80129-2255
Mailing Address - Country:US
Mailing Address - Phone:303-805-2222
Mailing Address - Fax:303-805-2226
Practice Address - Street 1:19641 E PARKER SQUARE DR STE E
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-7397
Practice Address - Country:US
Practice Address - Phone:303-805-2222
Practice Address - Fax:303-805-2226
Is Sole Proprietor?:No
Enumeration Date:2019-05-24
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDO-1697207Q00000X, 207QA0401X
CODR.0071075207QA0401X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine