Individual
DR. BRIAN P GRADISEK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Contact information
Practice address
1400 28TH ST STE 2, BOULDER, CO 80303-1096
(303) 449-2000
(303) 449-9475
Mailing address
1400 28TH ST STE 2, BOULDER, CO 80303-1096
(303) 449-2000
(303) 449-9475
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
016005597
IL
213ES0103X
Foot & Ankle Surgery Podiatrist
0000766
CO
213ES0103X
Foot & Ankle Surgery Podiatrist
016005597
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
016005597
—
IL
Enumeration date
05/05/2011
Last updated
07/27/2016
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