Healthcare Provider Details

I. General information

NPI: 1538096185
Provider Name (Legal Business Name): OLIVER KRISHNAN PARANJOTHI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1815 JET WING DR
COLORADO SPRINGS CO
80916-2300
US

IV. Provider business mailing address

3205 N ACADEMY BLVD STE 130
COLORADO SPRINGS CO
80917-5152
US

V. Phone/Fax

Practice location:
  • Phone: 719-632-5700
  • Fax:
Mailing address:
  • Phone: 719-632-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.0009937
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: