Provider Demographics
NPI:1891090288
Name:KSIAZEK MEDICAL SERVICES P.C.
Entity Type:Organization
Organization Name:KSIAZEK MEDICAL SERVICES P.C.
Other - Org Name:KAREN KSIAZEK MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:KSIAZEK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-934-3600
Mailing Address - Street 1:65 S WADSWORTH BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80226-1513
Mailing Address - Country:US
Mailing Address - Phone:303-934-3600
Mailing Address - Fax:303-934-1559
Practice Address - Street 1:65 S WADSWORTH BLVD
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226-1513
Practice Address - Country:US
Practice Address - Phone:303-934-3600
Practice Address - Fax:303-934-1559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-17
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO30621208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01306216Medicaid