Provider Demographics
NPI:1356370191
Name:SARINOPOULOS, MARK (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:SARINOPOULOS
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 1:198 W SYCAMORE LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-2234
Mailing Address - Country:US
Mailing Address - Phone:303-358-6329
Mailing Address - Fax:
Practice Address - Street 1:1420 W MIDWAY BLVD
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-2090
Practice Address - Country:US
Practice Address - Phone:303-466-1866
Practice Address - Fax:303-466-4081
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2017-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO38117207Q00000X, 207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
COSA549988OtherBC/BS
CO75129728Medicaid
COSA549988OtherBC/BS
CO514108Medicare ID - Type Unspecified