Provider Demographics
NPI:1386795656
Name:CASTLE ROCK FAMILY PHYSICIANS, P.C.
Entity type:Organization
Organization Name:CASTLE ROCK FAMILY PHYSICIANS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:BAIRD
Authorized Official - Last Name:KASUNIC
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:303-688-8989
Mailing Address - Street 1:755 S PERRY ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-1901
Mailing Address - Country:US
Mailing Address - Phone:303-688-8989
Mailing Address - Fax:303-688-3482
Practice Address - Street 1:755 S PERRY ST
Practice Address - Street 2:SUITE 100
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-1901
Practice Address - Country:US
Practice Address - Phone:303-688-8989
Practice Address - Fax:303-688-3482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-15
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO28038207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC370408Medicare PIN