Basic Information
Provider Information
NPI: 1164679833
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MOORTHY
FirstName: RISHI
MiddleName: K.
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 333 W HAMPDEN AVE
Address2: SUITE #600
City: ENGLEWOOD
State: CO
PostalCode: 801102330
CountryCode: US
TelephoneNumber: 3037615646
FaxNumber: 7204399500
Practice Location
Address1: 333 W HAMPDEN AVE
Address2: SUITE #600
City: ENGLEWOOD
State: CO
PostalCode: 801102330
CountryCode: US
TelephoneNumber: 3037615646
FaxNumber: 7204399500
Other Information
ProviderEnumerationDate: 08/25/2008
LastUpdateDate: 08/04/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207L00000X55712COY Allopathic & Osteopathic PhysiciansAnesthesiology 
207L00000X037340DCN Allopathic & Osteopathic PhysiciansAnesthesiology 

No ID Information.


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