Provider Demographics
NPI:1770726101
Name:ILVONEN, ROGER PAUL (MD)
Entity type:Individual
Prefix:DR
First Name:ROGER
Middle Name:PAUL
Last Name:ILVONEN
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 1:2337 S YOUNGFIELD WAY
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-4970
Mailing Address - Country:US
Mailing Address - Phone:303-986-2827
Mailing Address - Fax:303-986-5720
Practice Address - Street 1:2337 S YOUNGFIELD WAY
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-4970
Practice Address - Country:US
Practice Address - Phone:303-986-2827
Practice Address - Fax:303-986-5720
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-15
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO18649207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1186493Medicaid
CO1186493Medicaid