Healthcare Provider Details

I. General information

NPI: 1649565227
Provider Name (Legal Business Name): JOSHUA PAUL WINTJE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JOSHUA P. WINTJE MD

II. Dates (important events)

Enumeration Date: 06/13/2011
Last Update Date: 10/23/2020
Certification Date: 10/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5183 S LAREDO WAY
CENTENNIAL CO
80015-4151
US

IV. Provider business mailing address

5183 S LAREDO WAY
CENTENNIAL CO
80015-4151
US

V. Phone/Fax

Practice location:
  • Phone: 706-224-0692
  • Fax: 318-225-8243
Mailing address:
  • Phone: 706-224-0692
  • Fax: 318-225-8243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number54528
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberDR.0054528
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateTN
# 4
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberDR.0054528
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: