Provider Demographics
NPI:1952367880
Name:PTASZKIEWICZ, MATTHEW JOHN (M D)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:JOHN
Last Name:PTASZKIEWICZ
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2127 E HARMONY RD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80528-3405
Mailing Address - Country:US
Mailing Address - Phone:970-297-6250
Mailing Address - Fax:970-297-6260
Practice Address - Street 1:2127 E HARMONY RD
Practice Address - Street 2:STE 140
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80528-3405
Practice Address - Country:US
Practice Address - Phone:970-297-6250
Practice Address - Fax:970-297-6260
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301074851207Q00000X
CO49467207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
COP00970417OtherMEDICARE RAILROAD
CO04380771Medicaid
MI4671925-10Medicaid
COCOA103988Medicare PIN
MI0P03230Medicare ID - Type Unspecified
MI4671925-10Medicaid