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1265404685

NPI Code Detail

MEDICARE: DR. DIOGO TAVARES BAULETH MD

MEDICARE: DR. DIOGO TAVARES BAULETH MD

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	207R00000X	Internal Medicine Physician	40501	CO
2	208M00000X	Hospitalist Physician	DR.0040501	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	028985	OTHER	CO	KAISER COMMERCIAL NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265404685
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DIOGO TAVARES BAULETH MD

Provider Business Mailing Address
First Line	:	10350 E DAKOTA AVE
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80247-1314
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1375 E 19TH AVE
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80218-1114
Country	:	US
Telephone Number	:	303-338-4545
Fax Number	:

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

Provider Enumeration Date	:	02/02/2006
Last Update Date	:	05/11/2021

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Directions to “ DR. DIOGO TAVARES BAULETH MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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