Provider Demographics
NPI:1730369323
Name:FRONT RANGE SPINE AND NEUROSURGERY
Entity type:Organization
Organization Name:FRONT RANGE SPINE AND NEUROSURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:RAUZZINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-790-1800
Mailing Address - Street 1:10099 RIDGEGATE PKWY STE 310
Mailing Address - Street 2:
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-5534
Mailing Address - Country:US
Mailing Address - Phone:303-947-5838
Mailing Address - Fax:
Practice Address - Street 1:10099 RIDGEGATE PKWY STE 310
Practice Address - Street 2:
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-5534
Practice Address - Country:US
Practice Address - Phone:303-947-5838
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-12
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
42121207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO02570866Medicaid
COC802477Medicare PIN
COF84066Medicare UPIN