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General NPI Number Information
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NPI Number | 1043472400
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Entity Type | Individual
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Provider Name | PANTELIS HADJIZACHARIA M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/26/2008
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Last Update Date | 07/07/2025
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Provider Practice Location Address
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Address Line | 1401 COURT ST
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City | PUEBLO
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State | CO
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Zip | 81003-2715
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Country | US
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Telephone | 719-562-2300
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 560825
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City | DENVER
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State | CO
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Zip | 80256-0825
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Country | US
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Telephone | 719-595-7580
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Fax | 719-595-7417
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | R70524
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | DR.0054955
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 48372
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License Number State | AZ
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Taxonomy #4
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | CDRH.0054955
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License Number State | CO
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