Provider Demographics
NPI:1902878291
Name:OLESZEK, KENNETH GERALD (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:GERALD
Last Name:OLESZEK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2774 E 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-4808
Mailing Address - Country:US
Mailing Address - Phone:303-355-4772
Mailing Address - Fax:
Practice Address - Street 1:2774 E 2ND AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-4808
Practice Address - Country:US
Practice Address - Phone:303-355-4772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO32815207R00000X, 202K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No202K00000XAllopathic & Osteopathic PhysiciansPhlebology