Provider Demographics
NPI:1851489918
Name:KORTZ, WARREN J (MD)
Entity Type:Individual
Prefix:
First Name:WARREN
Middle Name:J
Last Name:KORTZ
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 1:2555 S DOWNING ST
Mailing Address - Street 2:STE. 130
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-5855
Mailing Address - Country:US
Mailing Address - Phone:303-777-7112
Mailing Address - Fax:303-722-0201
Practice Address - Street 1:2555 S DOWNING ST
Practice Address - Street 2:STE. 130
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-5855
Practice Address - Country:US
Practice Address - Phone:303-777-7112
Practice Address - Fax:303-722-0201
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO26516208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01265164Medicaid
CO349418Medicare PIN
COD28393Medicare UPIN