Basic Information
| Provider Information | |||||||||
| NPI: | 1205813045 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FLEISHMAN | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10700 E GEDDES AVE | ||||||||
| Address2: | NO 200 | ||||||||
| City: | ENGLEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801123800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037619190 | ||||||||
| FaxNumber: | 7208744462 | ||||||||
| Practice Location | |||||||||
| Address1: | 501 E HAMPDEN AVE | ||||||||
| Address2: | |||||||||
| City: | ENGLEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801132702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037619190 | ||||||||
| FaxNumber: | 7208744462 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/22/2005 | ||||||||
| LastUpdateDate: | 04/07/2017 | ||||||||
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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 | 2085R0202X | 36073 | CO | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | 25171 | NE | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | 04-36482 | KS | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | MD17546 | HI | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 1205813045 | 05 | WY | MEDICAID | Q36073 | 05 | SC | MEDICAID | 200418240A | 05 | KS | MEDICAID | 919772 | 05 | AZ | MEDICAID | 01360734 | 05 | CO | MEDICAID | 7616905 | 05 | NC | MEDICAID | 009981095 | 05 | AL | MEDICAID | 1205813045 | 05 | IL | MEDICAID | 204035901 | 05 | MO | MEDICAID | 807434700 | 05 | ID | MEDICAID | 95425764 | 05 | NM | MEDICAID | XPY201229 | 05 | CA | MEDICAID | 02300154 | 05 | NY | MEDICAID | 104686122 | 05 | MI | MEDICAID | 1679513196 | 05 | UT | MEDICAID | 1205813045 | 05 | IN | MEDICAID | 1205813045 | 05 | IA | MEDICAID | 947491205A | 05 | GA | MEDICAID | 0000341479 | 01 | HI | HMSA ALL PRODUCTS | OTHER | 10025709000 | 05 | NE | MEDICAID | 1205813045 | 05 | MT | MEDICAID | 84-059792913 | 05 | NE | MEDICAID |