Basic Information
| Provider Information | |||||||||
| NPI: | 1669652335 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PIERACCI | ||||||||
| FirstName: | FREDRIC | ||||||||
| MiddleName: | MICHAEL | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D., M.P.H. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 777 BANNOCK ST | ||||||||
| Address2: | MC0206 | ||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802044507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034364029 | ||||||||
| FaxNumber: | 3034366572 | ||||||||
| Practice Location | |||||||||
| Address1: | 777 BANNOCK ST | ||||||||
| Address2: | MC0206 | ||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802044507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034364029 | ||||||||
| FaxNumber: | 3034366572 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2007 | ||||||||
| LastUpdateDate: | 11/12/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 232755 | NY | N | Allopathic & Osteopathic Physicians | Surgery | 207RB0002X | 48205 | CO | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Bariatric Medicine | 208600000X | 48205 | CO | N | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.