Individual
SUSAN KOTAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1400 JACKSON ST, DENVER, CO 80206-2761
(303) 388-4461
(303) 270-2206
Mailing address
1400 JACKSON ST, DENVER, CO 80206-2761
(303) 388-4461
(303) 398-1211
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
39847
CO
207RP1001X
Pulmonary Disease Physician
Primary
39847
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
77603354
—
CO
Enumeration date
08/24/2006
Last updated
11/12/2020
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