Provider Demographics
NPI:1124083456
Name:RESNICK, STEVEN D (MD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:D
Last Name:RESNICK
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 1:3575 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-1825
Mailing Address - Country:US
Mailing Address - Phone:303-449-0933
Mailing Address - Fax:303-447-0794
Practice Address - Street 1:3575 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-1825
Practice Address - Country:US
Practice Address - Phone:303-449-0933
Practice Address - Fax:303-447-0794
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2017-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY199481207N00000X
CO0058506207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO37125036Medicaid
NY01576365Medicaid
CO37125036Medicaid
NY01576365Medicaid