Healthcare Provider Details

I. General information

NPI: 1972962421
Provider Name (Legal Business Name): SATEJ RANJIT PRADHAN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2016
Last Update Date: 02/06/2023
Certification Date: 02/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10TH MEDICAL GROUP 4102 PINION DRIVE
USAF ACADEMY CO
80840
US

IV. Provider business mailing address

10TH MEDICAL GROUP 4102 PINION DRIVE
USAF ACADEMY CO
80840
US

V. Phone/Fax

Practice location:
  • Phone: 719-333-0325
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberDR.0059248
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberDR.0059428
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: