Provider Demographics
NPI:1700074846
Name:PRESKEN, DEBORAH
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:PRESKEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6240 S MAIN ST STE 255
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80016-5412
Mailing Address - Country:US
Mailing Address - Phone:303-928-7555
Mailing Address - Fax:303-928-7560
Practice Address - Street 1:6240 S MAIN ST STE 255
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80016-5412
Practice Address - Country:US
Practice Address - Phone:303-928-7555
Practice Address - Fax:303-928-7560
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-12
Last Update Date:2013-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO42711207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO44120265Medicaid
CO44120265Medicaid
543478Medicare PIN