Provider Demographics
NPI:1649253832
Name:SOKOLOWSKI, IRENE L (MD)
Entity type:Individual
Prefix:
First Name:IRENE
Middle Name:L
Last Name:SOKOLOWSKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:IRENE
Other - Middle Name:L
Other - Last Name:DAUTZENBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1627 E 18TH ST
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-4209
Mailing Address - Country:US
Mailing Address - Phone:970-663-0135
Mailing Address - Fax:970-461-1422
Practice Address - Street 1:1900 BOISE AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-5004
Practice Address - Country:US
Practice Address - Phone:970-667-2009
Practice Address - Fax:970-667-2103
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO42364207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO97357511Medicaid
ID807393100Medicaid
WY124498100Medicaid
COSO669097OtherANTHEM BCBS
COP00322068Medicare PIN
COG93123Medicare UPIN
COC553378Medicare PIN