Basic Information
| Provider Information | |||||||||
| NPI: | 1003254202 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PATEL | ||||||||
| FirstName: | PRACHI | ||||||||
| MiddleName: | TONI | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5450 WESTERN AVE | ||||||||
| Address2: | |||||||||
| City: | BOULDER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 803012709 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034154157 | ||||||||
| FaxNumber: | 3037763109 | ||||||||
| Practice Location | |||||||||
| Address1: | 2101 KEN PRATT BLVD STE 104 | ||||||||
| Address2: | |||||||||
| City: | LONGMONT | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805016568 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034154157 | ||||||||
| FaxNumber: | 3037763109 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2013 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | DR.0057563 | CO | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.