Provider Demographics
NPI:1699316711
Name:ENDOVASCULAR CONSULTANTS OF COLORADO PC
Entity type:Organization
Organization Name:ENDOVASCULAR CONSULTANTS OF COLORADO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:C
Authorized Official - Last Name:KOVALESKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:720-668-8818
Mailing Address - Street 1:536 MEADOWLEAF LN
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80126-5712
Mailing Address - Country:US
Mailing Address - Phone:501-425-8489
Mailing Address - Fax:
Practice Address - Street 1:8080 PARK MEADOWS DR STE 150
Practice Address - Street 2:
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-2566
Practice Address - Country:US
Practice Address - Phone:720-668-8818
Practice Address - Fax:720-710-9492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-30
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CODR.0059870OtherCOLORADO MEDICAL LICENSE
CO9000161370Medicaid