Basic Information
| Provider Information | |||||||||
| NPI: | 1649705427 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JUDISCAK | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | MICHAEL | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10099 RIDGEGATE PKWY | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | LONE TREE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801245531 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7196714054 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 7700 S BROADWAY | ||||||||
| Address2: | |||||||||
| City: | LITTLETON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801222602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037308900 | ||||||||
| FaxNumber: | 3037387755 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/28/2017 | ||||||||
| LastUpdateDate: | 07/21/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | TL.0006558 | CO | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | DR.0062246 | CO | Y | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.