Basic Information
| Provider Information | |||||||||
| NPI: | 1568603645 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KRATZENBERG | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | M. | ||||||||
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| Credential: | P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13701 E. MISSISSIPPI AVENUE | ||||||||
| Address2: | SUITE 320 | ||||||||
| City: | AURORA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80012 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3033403378 | ||||||||
| FaxNumber: | 3033403409 | ||||||||
| Practice Location | |||||||||
| Address1: | 13701 E MISSISSIPPI AVE | ||||||||
| Address2: | SUITE 320 | ||||||||
| City: | AURORA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800126141 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3033403378 | ||||||||
| FaxNumber: | 3033403409 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/18/2009 | ||||||||
| LastUpdateDate: | 04/28/2011 | ||||||||
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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 | 363A00000X | 013208 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.