Healthcare Provider Details

I. General information

NPI: 1316502057
Provider Name (Legal Business Name): ZEESHAN ZIA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2019
Last Update Date: 05/15/2025
Certification Date: 05/15/2025
Deactivation Date: 12/16/2019
Reactivation Date: 02/26/2020

III. Provider practice location address

400 W 16TH ST
PUEBLO CO
81003-2745
US

IV. Provider business mailing address

1600 N GRAND AVE STE 140
PUEBLO CO
81003-2755
US

V. Phone/Fax

Practice location:
  • Phone: 719-484-4000
  • Fax:
Mailing address:
  • Phone: 719-564-1542
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberDR.0069173
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number27018
License Number StateNV
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number27018
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: