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NPI Code Detail

MEDICARE: DR. MARK KARDOS TUTTLE M.D.

MEDICARE: DR. MARK KARDOS TUTTLE M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician261600MA
2207RC0000XCardiovascular Disease Physician261600MA
3207RI0011XInterventional Cardiology Physician261600MA

General Provider Information

NPI Number : 1194086900
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARK KARDOS TUTTLE M.D.
Provider Business Mailing Address
First Line : 1801 16TH ST
Second Line :
City : GREELEY
State : CO
Zip : 80631-5154
Country : US
Telephone Number : 970-810-0900
Fax Number :
Provider Business Practice Location Address
First Line : 1801 16TH ST
Second Line :
City : GREELEY
State : CO
Zip : 80631-5199
Country : US
Telephone Number : 970-810-0900
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/07/2012
Last Update Date : 03/04/2022

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