Provider Demographics
NPI:1235635251
Name:DANEK, DAGMARA (DO)
Entity type:Individual
Prefix:
First Name:DAGMARA
Middle Name:
Last Name:DANEK
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1440 28TH ST STE 3
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-1030
Mailing Address - Country:US
Mailing Address - Phone:303-900-8807
Mailing Address - Fax:035-787-8233
Practice Address - Street 1:1440 28TH ST STE 3
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-1030
Practice Address - Country:US
Practice Address - Phone:303-900-8807
Practice Address - Fax:303-578-7823
Is Sole Proprietor?:No
Enumeration Date:2018-03-30
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0073000207W00000X
IL036.161303207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000232745Medicaid