Healthcare Provider Details

I. General information

NPI: 1043472400
Provider Name (Legal Business Name): PANTELIS HADJIZACHARIA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2008
Last Update Date: 07/07/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 COURT ST
PUEBLO CO
81003-2715
US

IV. Provider business mailing address

PO BOX 560825
DENVER CO
80256-0825
US

V. Phone/Fax

Practice location:
  • Phone: 719-562-2300
  • Fax:
Mailing address:
  • Phone: 719-595-7580
  • Fax: 719-595-7417

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberDR.0054955
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberR70524
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number48372
License Number StateAZ
# 4
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberCDRH.0054955
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: