Basic Information
| Provider Information | |||||||||
| NPI: | 1811004161 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALISKY | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MD PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10900 W 44TH AVE | ||||||||
| Address2: | UNIT 200 | ||||||||
| City: | WHEAT RIDGE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800332742 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3039931330 | ||||||||
| FaxNumber: | 3032844082 | ||||||||
| Practice Location | |||||||||
| Address1: | 12250 E ILIFF AVE | ||||||||
| Address2: | #300 | ||||||||
| City: | AURORA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800146318 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3033064321 | ||||||||
| FaxNumber: | 7205241551 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2006 | ||||||||
| LastUpdateDate: | 01/30/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0300X | 47268 | CO | N | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine | 207R00000X | 47268 | CO | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 56133243 | 05 | CO | MEDICAID |