Healthcare Provider Details

I. General information

NPI: 1417169574
Provider Name (Legal Business Name): YADAVINDER SINGH SOOCH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 11/08/2025
Certification Date: 11/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 N NEVADA AVE
COLORADO SPRINGS CO
80907-6819
US

IV. Provider business mailing address

417 E KIOWA ST UNIT 1106
COLORADO SPRINGS CO
80903-8411
US

V. Phone/Fax

Practice location:
  • Phone: 719-475-0299
  • Fax:
Mailing address:
  • Phone: 816-699-1203
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number84371
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number46708
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number1251
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: