Gradisek, Brian P

Gradisek, Brian P is an individual health care provider with primary practice located at 1400 28Th St Ste 2 , Boulder CO 80303-1096. He recently has 2 registered licenses in different health care specialties including Podiatric Medicine & Surgery Service Providers / Podiatrist, Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery. Podiatric Medicine & Surgery Service Providers / Podiatrist is his primary health care specialty. Gradisek, Brian P can be contacted via phone (303) 449-2000.

Contact Information

Primary practice address
1400 28Th St Ste 2 Boulder CO 80303-1096
Phone: (303) 449-2000
Fax: (303) 449-9475
Website:
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Health care specialties

SpecialtyCodeLicense #State
Podiatric Medicine & Surgery Service Providers / Podiatrist 213E00000X 016005597 Illinois
Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery 213ES0103X 016005597 Illinois
Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery 213ES0103X 0000766 Colorado

Profile Details

NPI number 1700178092
LBN Legal business name Gradisek, Brian P
Credentials Doctor of Podiatric Medicine (DPM)
Entity Individual
Sole proprietor 1 No
Enumeration date May 5th, 2011
Last updated Jul 27th, 2016 - about 10 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1700178092 NPPES
Illinois MEDICAID 016005597

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