1902908791 NPI number — DR. AMRITA K DHALIWAL OD

Table of content: DR. AMRITA K DHALIWAL OD (NPI 1902908791)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902908791 NPI number — DR. AMRITA K DHALIWAL OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DHALIWAL
Provider First Name:
AMRITA
Provider Middle Name:
K
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1902908791
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
295 E SPEER BLVD APT 634
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DENVER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80203-3576
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-232-3787
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10001 WASHINGTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
THORNTON
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80229-2050
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-451-8075
Provider Business Practice Location Address Fax Number:
303-457-9859
Provider Enumeration Date:
09/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  0003283 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1044035 . This is a "AMERICA'S PPO" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 2203199 . This is a "MEDICA/UNITED HEALTH CARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 183M2PE . This is a "BCBS/MN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 799167300 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: MN3006 . This is a "EYEMED" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 185171045937 . This is a "PREFERRED ONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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