Provider Demographics
NPI:1629099320
Name:GITTELMAN, STEVEN S (CRNA)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:S
Last Name:GITTELMAN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25587 CONIFER RD
Mailing Address - Street 2:SUITE 105-603
Mailing Address - City:CONIFER
Mailing Address - State:CO
Mailing Address - Zip Code:80433-9067
Mailing Address - Country:US
Mailing Address - Phone:303-204-5129
Mailing Address - Fax:303-416-4246
Practice Address - Street 1:25587 CONIFER RD
Practice Address - Street 2:SUITE 105-603
Practice Address - City:CONIFER
Practice Address - State:CO
Practice Address - Zip Code:80433-9067
Practice Address - Country:US
Practice Address - Phone:303-204-5129
Practice Address - Fax:303-416-4246
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN0003520-CRNA367500000X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO98957520Medicaid
NM9603271Medicaid
CO98957520Medicaid
NM264737YMQHOtherMEDICARE
CO452098Medicare ID - Type Unspecified
NM9603271Medicaid
CO98957520Medicaid