Healthcare Provider Details

I. General information

NPI: 1376926725
Provider Name (Legal Business Name): KRUTI SHIVLAL PATEL M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2015
Last Update Date: 07/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 N GRAND AVE STE 400
PUEBLO CO
81003-2760
US

IV. Provider business mailing address

PO BOX 560825
DENVER CO
80256-0825
US

V. Phone/Fax

Practice location:
  • Phone: 719-585-2500
  • Fax: 719-543-1041
Mailing address:
  • Phone: 719-595-7580
  • Fax: 719-545-0176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number4301108331
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberDR.0062298
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: