MEDICARE: PETRA CHLADEK PAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1359	OTHER		COLORADO STATE LICENSE

General Provider Information

NPI Number	:	1619938859
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETRA CHLADEK PAC

Provider Business Mailing Address
First Line	:	940 CENTRAL PARK DR STE 210
Second Line	:
City	:	STEAMBOAT SPRINGS
State	:	CO
Zip	:	80487-8853
Country	:	US
Telephone Number	:	970-871-4811
Fax Number	:

Provider Business Practice Location Address
First Line	:	940 CENTRAL PARK DR STE 210
Second Line	:
City	:	STEAMBOAT SPRINGS
State	:	CO
Zip	:	80487-8853
Country	:	US
Telephone Number	:	970-871-4811
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/29/2006
Last Update Date	:	03/07/2023

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