MEDICARE: DIANE H PELTO 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	207L00000X	Anesthesiology Physician	DR.0035998	CO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	050050074	OTHER	CO	RAILROAD MEDICARE NUMBER

Other Identifiers

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

General Provider Information

NPI Number	:	1568456960
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANE H PELTO M.D.

Provider Business Mailing Address
First Line	:	4 OAK AVE
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80906-3260
Country	:	US
Telephone Number	:	719-434-7019
Fax Number	:	719-487-0005

Provider Business Practice Location Address
First Line	:	4 OAK AVE
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80906-3260
Country	:	US
Telephone Number	:	719-434-7019
Fax Number	:	719-487-0005

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

Provider Enumeration Date	:	08/31/2005
Last Update Date	:	10/17/2016

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