Provider Demographics
NPI:1720063324
Name:LAKE-BAKAAR, GEROND V (MD)
Entity type:Individual
Prefix:DR
First Name:GEROND
Middle Name:V
Last Name:LAKE-BAKAAR
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 1:2535 S DOWNING ST
Mailing Address - Street 2:STE 380
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-5847
Mailing Address - Country:US
Mailing Address - Phone:303-778-5797
Mailing Address - Fax:
Practice Address - Street 1:422 RIDGE RD
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80403-1595
Practice Address - Country:US
Practice Address - Phone:516-314-8736
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY164621207RG0100X
MA233492207RI0008X, 207RT0003X
CO57128207RI0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0008XAllopathic & Osteopathic PhysiciansInternal MedicineHepatology
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207RT0003XAllopathic & Osteopathic PhysiciansInternal MedicineTransplant Hepatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO44705034Medicaid
NY00968378Medicaid
NY00968378Medicaid
CO551192YLTTMedicare PIN
CO44705034Medicaid