Basic Information
Provider Information | |||||||||
NPI: | 1144296229 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | FRITZ | ||||||||
FirstName: | KARL | ||||||||
MiddleName: | P | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 455 SHERMAN ST | ||||||||
Address2: | STE 510 | ||||||||
City: | DENVER | ||||||||
State: | CO | ||||||||
PostalCode: | 802034400 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3033776825 | ||||||||
FaxNumber: | 3037800787 | ||||||||
Practice Location | |||||||||
Address1: | 455 SHERMAN ST | ||||||||
Address2: | STE 510 | ||||||||
City: | DENVER | ||||||||
State: | CO | ||||||||
PostalCode: | 802034400 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3033776825 | ||||||||
FaxNumber: | 3037800787 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 02/27/2006 | ||||||||
LastUpdateDate: | 12/19/2013 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 35508 | CO | N |   | Allopathic & Osteopathic Physicians | Anesthesiology |   | 207LP3000X | 35508 | CO | Y |   | Allopathic & Osteopathic Physicians | Anesthesiology | Pediatric Anesthesiology |
ID Information
ID | Type | State | Issuer | Description | 01355080 | 05 | CO |   | MEDICAID | 112637700 | 05 | WY |   | MEDICAID | 10026287900 | 05 | NE |   | MEDICAID |