Provider Demographics
NPI:1982630588
Name:OSTERDOCK, RENATTA J (MD)
Entity Type:Individual
Prefix:DR
First Name:RENATTA
Middle Name:J
Last Name:OSTERDOCK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:RENATTA
Other - Middle Name:J
Other - Last Name:OSTERDOCK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1601 E 19TH AVE
Mailing Address - Street 2:SUITE 4600
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-1289
Mailing Address - Country:US
Mailing Address - Phone:303-832-2449
Mailing Address - Fax:303-832-3832
Practice Address - Street 1:1601 E 19TH AVE STE 4600
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1289
Practice Address - Country:US
Practice Address - Phone:303-832-2449
Practice Address - Fax:303-832-3832
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-24
Last Update Date:2017-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO46246207T00000X, 207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A772480Medicaid
H54950Medicare UPIN
00A772480Medicare ID - Type Unspecified
CA00A772480Medicaid