Healthcare Provider Details

I. General information

NPI: 1124068291
Provider Name (Legal Business Name): THEA A WOJTKOWSKI KHAN-FAROOQI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: THEA A WOJTKOWSKI MD

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 11/25/2020
Certification Date: 11/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

627 25 1/2 RD
GRAND JUNCTION CO
81505-6401
US

IV. Provider business mailing address

181 W MEADOW DR STE 400
VAIL CO
81657-5058
US

V. Phone/Fax

Practice location:
  • Phone: 970-242-3535
  • Fax: 970-623-8599
Mailing address:
  • Phone: 970-476-1100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD00044171
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number47982
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: