Basic Information
| Provider Information | |||||||||
| NPI: | 1952367880 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PTASZKIEWICZ | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | JOHN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M. D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2127 E HARMONY RD | ||||||||
| Address2: | SUITE 140 | ||||||||
| City: | FORT COLLINS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805283405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9702976250 | ||||||||
| FaxNumber: | 9702976260 | ||||||||
| Practice Location | |||||||||
| Address1: | 2127 E HARMONY RD | ||||||||
| Address2: | STE 140 | ||||||||
| City: | FORT COLLINS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805283405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9702976250 | ||||||||
| FaxNumber: | 9702976260 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2006 | ||||||||
| LastUpdateDate: | 06/12/2014 | ||||||||
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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 | 207Q00000X | 4301074851 | MI | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 49467 | CO | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | P00970417 | 01 | CO | MEDICARE RAILROAD | OTHER | 04380771 | 05 | CO | MEDICAID | 4671925-10 | 05 | MI | MEDICAID |