Basic Information
| Provider Information | |||||||||
| NPI: | 1780616466 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RICHMAN | ||||||||
| FirstName: | LEE | ||||||||
| MiddleName: | KENNETH | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1707 COLE BLVD. | ||||||||
| Address2: | STE. #100 | ||||||||
| City: | GOLDEN | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037168013 | ||||||||
| FaxNumber: | 3037635495 | ||||||||
| Practice Location | |||||||||
| Address1: | 1536 COLE BLVD | ||||||||
| Address2: | STE. #250 | ||||||||
| City: | LAKEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 804013413 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037168027 | ||||||||
| FaxNumber: | 3032385258 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2006 | ||||||||
| LastUpdateDate: | 04/18/2016 | ||||||||
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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 | 207RG0100X | 19695 | CO | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 01196955 | 05 | CO | MEDICAID | 100010930 | 01 | CO | RAILROAD MEDICARE | OTHER | CN2698 | 01 | CO | MEDICARE | OTHER |