MEDICARE: DR. SIPA PRABHA PATEL D.O.

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
1	207Q00000X	Family Medicine Physician	25MB09379800	NJ
2	207Q00000X	Family Medicine Physician	DR.0055610	CO

General Provider Information

NPI Number	:	1245511344
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SIPA PRABHA PATEL D.O.

Provider Business Mailing Address
First Line	:	1263 LAKE PLAZA DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80906-3564
Country	:	US
Telephone Number	:	719-776-3300
Fax Number	:	719-776-3329

Provider Business Practice Location Address
First Line	:	1263 LAKE PLAZA DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80906-3564
Country	:	US
Telephone Number	:	719-776-3300
Fax Number	:	719-776-3329

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/01/2011
Last Update Date	:	09/26/2024

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