Basic Information
| Provider Information | |||||||||
| NPI: | 1316151913 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KAMINSKY | ||||||||
| FirstName: | IAN | ||||||||
| MiddleName: | A. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10700 E GEDDES AVE STE 200 | ||||||||
| Address2: | |||||||||
| City: | ENGLEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801123861 | ||||||||
| 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: | 05/10/2007 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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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 | 2085N0700X | 258700 | MA | N | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology | 2085R0202X | 260319 | NY | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | 58053 | CO | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 207R00000X | 4301088704 | MI | N | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 111257105 | 01 | KS | MEDICARE PIN | OTHER | 561515YQ33 | 01 | CO | MEDICARE PIN | OTHER | 561515YQ3L | 01 | CO | MEDICARE PIN | OTHER | 561515ZNTB | 01 | CO | MEDICARE PIN | OTHER | 561515ZLJ3 | 01 | CO | MEDICARE PIN | OTHER | NA2517097 | 01 | NE | MEDICARE PIN | OTHER | 561515YQPG | 01 | CO | MEDICARE PIN | OTHER | KA324096 | 01 | KS | MEDICARE PIN | OTHER | NA1214118 | 01 | NE | MEDICARE PIN | OTHER | 1316151913 | 05 | CO | MEDICAID | 561515YQN9 | 01 | CO | MEDICARE PIN | OTHER | NA1215119 | 01 | NE | MEDICARE PIN | OTHER |