Healthcare Provider Details

I. General information

NPI: 1629495973
Provider Name (Legal Business Name): PRANEETH KUDARAVALLI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2014
Last Update Date: 08/30/2024
Certification Date: 08/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2535 S DOWNING ST STE 410
DENVER CO
80210-5851
US

IV. Provider business mailing address

2535 S DOWNING ST STE 410
DENVER CO
80210-5851
US

V. Phone/Fax

Practice location:
  • Phone: 303-260-2740
  • Fax: 303-260-2741
Mailing address:
  • Phone: 303-260-2740
  • Fax: 303-260-2741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number51420
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number88415
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number51420
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number88415
License Number StateGA
# 5
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberDR.0073095
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: