Basic Information
| Provider Information | |||||||||
| NPI: | 1417163536 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GRZEGOZEWSKI | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | CHARLES | ||||||||
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| OtherLastName: | GRZEGOZEWSKI | ||||||||
| OtherFirstName: | MATTHEW | ||||||||
| OtherMiddleName: | C. | ||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 173862 | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802173862 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3033067783 | ||||||||
| FaxNumber: | 3033067753 | ||||||||
| Practice Location | |||||||||
| Address1: | 10101 RIDGEGATE PARKWAY | ||||||||
| Address2: | |||||||||
| City: | LONE TREE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801249810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7202251900 | ||||||||
| FaxNumber: | 3033067753 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2007 | ||||||||
| LastUpdateDate: | 07/02/2015 | ||||||||
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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 | 207P00000X | D66242 | MD | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | DR.0052852 | CO | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | P01250125 | 01 | CO | RAILROAD MEDICARE | OTHER | 99936383 | 05 | CO | MEDICAID |