Healthcare Provider Details

I. General information

NPI: 1720296320
Provider Name (Legal Business Name): GEETIKA SRIVASTAVA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 02/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 N FOOTE AVE STE 202
COLORADO SPRINGS CO
80909-4501
US

IV. Provider business mailing address

2695 ROCKY MOUNTAIN AVE SUITE 150
LOVELAND CO
80538-8702
US

V. Phone/Fax

Practice location:
  • Phone: 719-365-6568
  • Fax: 719-365-6317
Mailing address:
  • Phone: 970-624-4443
  • Fax: 970-490-4175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberDR-52981
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: