Basic Information
| Provider Information | |||||||||
| NPI: | 1699316711 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ENDOVASCULAR CONSULTANTS OF COLORADO PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 536 MEADOWLEAF LN | ||||||||
| Address2: | |||||||||
| City: | HIGHLANDS RANCH | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801265712 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5014258489 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8080 PARK MEADOWS DR STE 150 | ||||||||
| Address2: | |||||||||
| City: | LONE TREE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801242566 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7206688818 | ||||||||
| FaxNumber: | 7207109492 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/30/2019 | ||||||||
| LastUpdateDate: | 01/26/2022 | ||||||||
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| AuthorizedOfficialLastName: | KOVALESKI | ||||||||
| AuthorizedOfficialFirstName: | AARON | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7206688818 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 01/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0204X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology |
ID Information
| ID | Type | State | Issuer | Description | DR.0059870 | 01 | CO | COLORADO MEDICAL LICENSE | OTHER | 9000161370 | 05 | CO | MEDICAID |