MEDICARE: DILAAWAR J. MISTRY 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
1	208100000X	Physical Medicine & Rehabilitation Physician	0101233275	VA
2	207R00000X	Internal Medicine Physician	49953	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437299468
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DILAAWAR J. MISTRY M.D.

Provider Business Mailing Address
First Line	:	1001A E HARMONY RD # 181
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-3354
Country	:	US
Telephone Number	:	434-760-1473
Fax Number	:

Provider Business Practice Location Address
First Line	:	2021 BATTLECREEK DR UNIT A
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80528-5120
Country	:	US
Telephone Number	:	883-992-2742
Fax Number	:	970-557-2326

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

Provider Enumeration Date	:	02/07/2007
Last Update Date	:	03/13/2019

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