| Medical Rtd Inc | |
|
7615 W 38th Ave Unit B-123 Wheat Ridge CO 80033-6172 | |
| (303) 432-2776 | |
| (303) 432-2216 |
| Full Name | Medical Rtd Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 7615 W 38th Ave, Wheat Ridge, Colorado |
| Authorized Official Name and Position | Tatyana I Datkhaeva (OWNER PHYSICIAN) |
| Authorized Official Contact | 7205407155 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Medical Rtd Inc 7615 W 38th Ave Unit B-123 Wheat Ridge CO 80033 Ph: (720) 540-7155 | Medical Rtd Inc 7615 W 38th Ave Unit B-123 Wheat Ridge CO 80033-6172 Ph: (303) 432-2776 |
| NPI Number | 1912030743 |
|---|---|
| Provider Enumeration Date | 03/13/2007 |
| Last Update Date | 03/07/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912030743 | NPI | - | NPPES |
| 45108 | Other | CO | STATE LICENSE |
| 82709513 | Medicaid | CO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 45108 (Colorado) | Primary |
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