Provider Demographics
NPI:1447471396
Name:CETINDAG, IBRAHIM BULENT (MD)
Entity type:Individual
Prefix:
First Name:IBRAHIM
Middle Name:BULENT
Last Name:CETINDAG
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:PO BOX 9049
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-9049
Mailing Address - Country:US
Mailing Address - Phone:303-415-4101
Mailing Address - Fax:303-415-4769
Practice Address - Street 1:4743 ARAPAHOE AVE STE 100
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-1123
Practice Address - Country:US
Practice Address - Phone:303-443-2123
Practice Address - Fax:303-443-9497
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2025-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-124001208600000X
COCDR.00050522086S0102X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036124001Medicaid
CO9000238182Medicaid