Healthcare Provider Details

I. General information

NPI: 1194086900
Provider Name (Legal Business Name): MARK KARDOS TUTTLE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2012
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1760 E KEN PRATT BLVD STE 205
LONGMONT CO
80504-5311
US

IV. Provider business mailing address

1801 16TH ST
GREELEY CO
80631-5154
US

V. Phone/Fax

Practice location:
  • Phone: 720-718-8180
  • Fax:
Mailing address:
  • Phone: 970-810-0900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberCDRH.0066228
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberCDRH.0066228
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: