Individual
DR. IHOR J FEDORAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2222 N NEVADA AVE, SUITE 5017, COLORADO SPRINGS, CO 80907-6831
(719) 635-2501
(719) 632-1062
Mailing address
2222 N NEVADA AVE, SUITE 5017, COLORADO SPRINGS, CO 80907-6831
(719) 635-2501
(719) 632-1062
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
33434
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01334341
—
CO
01
—
020048149
RAILROAD MEDICARE
—
01
—
5199598
AETNA PIN
—
01
—
IH35397
COLORADO BLUE SHIELD
CO
Enumeration date
02/21/2006
Last updated
07/08/2020
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