Provider Demographics
NPI:1962499863
Name:KONOPKA, DEREK JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:JOSEPH
Last Name:KONOPKA
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 1:7444 W ALASKA DR
Mailing Address - Street 2:STE 250
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80226-3327
Mailing Address - Country:US
Mailing Address - Phone:303-592-7284
Mailing Address - Fax:303-892-0601
Practice Address - Street 1:7444 W ALASKA DR
Practice Address - Street 2:STE 250
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226-3327
Practice Address - Country:US
Practice Address - Phone:303-592-7284
Practice Address - Fax:303-892-0601
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO24704207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1247048Medicaid
COC66263Medicare PIN
COCP4008Medicare PIN
CO1247048Medicaid
COCP4038Medicare PIN