Basic Information
| Provider Information | |||||||||
| NPI: | 1548693393 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CRUSAT | ||||||||
| FirstName: | NOLAN | ||||||||
| MiddleName: | JAMES KA'IO | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5200 DTC PKWY | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | GREENWOOD VILLAGE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801112709 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037450000 | ||||||||
| FaxNumber: | 3037733101 | ||||||||
| Practice Location | |||||||||
| Address1: | 5200 DTC PKWY | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | GREENWOOD VILLAGE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801112709 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037450000 | ||||||||
| FaxNumber: | 3037733101 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2013 | ||||||||
| LastUpdateDate: | 11/15/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | 54632 | CO | N | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | 54632 | CO | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 85380261 | 05 | CO | MEDICAID |