Healthcare Provider Details

I. General information

NPI: 1295715225
Provider Name (Legal Business Name): KARL PAUL DITTRICH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 10/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 S UNION BLVD SUITE 320
COLORADO SPRINGS CO
80910-3113
US

IV. Provider business mailing address

175 S UNION BLVD SUITE 320
COLORADO SPRINGS CO
80910-3113
US

V. Phone/Fax

Practice location:
  • Phone: 719-477-1033
  • Fax: 719-477-1037
Mailing address:
  • Phone: 719-477-1033
  • Fax: 719-477-1037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number38569
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: