Healthcare Provider Details

I. General information

NPI: 1962026351
Provider Name (Legal Business Name): VIGAN BAJRAKTARI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2020
Last Update Date: 02/25/2026
Certification Date: 02/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2555 E 13TH ST STE 105
LOVELAND CO
80537-5134
US

IV. Provider business mailing address

2555 E 13TH ST STE 105
LOVELAND CO
80537-5134
US

V. Phone/Fax

Practice location:
  • Phone: 970-810-0020
  • Fax: 970-810-0055
Mailing address:
  • Phone: 970-810-0020
  • Fax: 970-810-0055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.0006878
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: