Healthcare Provider Details

I. General information

NPI: 1114185022
Provider Name (Legal Business Name): ANUJ MEHTA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2008
Last Update Date: 05/09/2024
Certification Date: 05/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 BANNOCK ST
DENVER CO
80204-4507
US

IV. Provider business mailing address

1400 JACKSON STREET
DENVER CO
80206-2671
US

V. Phone/Fax

Practice location:
  • Phone: 303-602-5013
  • Fax:
Mailing address:
  • Phone: 303-388-4461
  • Fax: 303-398-1211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number56780
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number250001
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number56780
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: