Basic Information
| Provider Information | |||||||||
| NPI: | 1346411410 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ERIK W. KREUTZER, M.D., P.C., DBA COLORADO EAR, NOSE & THROAT GROUP | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 255 UNION BLVD | ||||||||
| Address2: | SUITE # 220 | ||||||||
| City: | LAKEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802281810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3032381366 | ||||||||
| FaxNumber: | 3032380038 | ||||||||
| Practice Location | |||||||||
| Address1: | 255 UNION BLVD | ||||||||
| Address2: | SUITE # 220 | ||||||||
| City: | LAKEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802281810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3032381366 | ||||||||
| FaxNumber: | 3032380038 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/17/2008 | ||||||||
| LastUpdateDate: | 03/17/2008 | ||||||||
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| AuthorizedOfficialLastName: | KREUTZER | ||||||||
| AuthorizedOfficialFirstName: | ERIK | ||||||||
| AuthorizedOfficialMiddleName: | WILLIAM | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3032381366 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Otolaryngology |
ID Information
| ID | Type | State | Issuer | Description | 04012019 | 05 | CO | MEDICAID |