Provider Demographics
NPI:1679584916
Name:KRESO, ERMIN (MD)
Entity type:Individual
Prefix:DR
First Name:ERMIN
Middle Name:
Last Name:KRESO
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 1:165 S SYRACUSE ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80230-6981
Mailing Address - Country:US
Mailing Address - Phone:303-341-5280
Mailing Address - Fax:303-341-7163
Practice Address - Street 1:496 S DAYTON ST
Practice Address - Street 2:SUITE C
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80247-6929
Practice Address - Country:US
Practice Address - Phone:303-341-5280
Practice Address - Fax:303-341-7163
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2017-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO45223207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO260267229005OtherROCKY MOUNTAIN HEALTH PLAN
CO68051336Medicaid
CO260267229005OtherROCKY MOUNTAIN HEALTH PLAN