Provider Demographics
NPI:1316151913
Name:KAMINSKY, IAN A (MD)
Entity type:Individual
Prefix:
First Name:IAN
Middle Name:A
Last Name:KAMINSKY
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 1:10800 E GEDDES AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80112-3895
Mailing Address - Country:US
Mailing Address - Phone:303-761-9190
Mailing Address - Fax:720-874-4462
Practice Address - Street 1:501 E HAMPDEN AVE
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-2702
Practice Address - Country:US
Practice Address - Phone:303-761-9190
Practice Address - Fax:720-874-4462
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301088704207R00000X
MA2587002085N0700X
NY2603192085R0202X
CO580532085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO561515ZLJ3OtherMEDICARE PIN
NENA2517097OtherMEDICARE PIN
CO561515YQPGOtherMEDICARE PIN
KSKA324096OtherMEDICARE PIN
NENA1214118OtherMEDICARE PIN
CO561515YQ33OtherMEDICARE PIN
CO561515YQ3LOtherMEDICARE PIN
CO561515YQN9OtherMEDICARE PIN
NENA1215119OtherMEDICARE PIN
CO1316151913Medicaid
KS111257105OtherMEDICARE PIN
CO561515ZNTBOtherMEDICARE PIN
CO561515ZLJ3Medicare PIN
KS111257105Medicare PIN
KSKA324096OtherMEDICARE PIN
CO561515YQ3LOtherMEDICARE PIN
CO561515YQN9Medicare PIN
KSKA3249096Medicare PIN
CO561515ZLJ3OtherMEDICARE PIN