Provider Demographics
NPI:1033547252
Name:BARAVIK, MARK (NP-C)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:
Last Name:BARAVIK
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 S POTOMAC ST STE 110
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-5433
Mailing Address - Country:US
Mailing Address - Phone:303-536-5020
Mailing Address - Fax:888-571-6309
Practice Address - Street 1:1550 S POTOMAC ST STE 110
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-5433
Practice Address - Country:US
Practice Address - Phone:303-536-5020
Practice Address - Fax:888-571-6309
Is Sole Proprietor?:No
Enumeration Date:2013-10-25
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0990941-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000153348Medicaid