Basic Information
| Provider Information | |||||||||
| NPI: | 1699060582 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STAHL | ||||||||
| FirstName: | COSETTE | ||||||||
| MiddleName: | M. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10700 E GEDDES AVE STE 200 | ||||||||
| Address2: | |||||||||
| City: | ENGLEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801123861 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037619190 | ||||||||
| FaxNumber: | 7208744462 | ||||||||
| Practice Location | |||||||||
| Address1: | 10700 E GEDDES AVE STE 200 | ||||||||
| Address2: | |||||||||
| City: | ENGLEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801123861 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037619190 | ||||||||
| FaxNumber: | 7208744462 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2011 | ||||||||
| LastUpdateDate: | 11/13/2018 | ||||||||
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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 | 2085R0204X | R1656 | TX | Y | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology |
ID Information
| ID | Type | State | Issuer | Description | NA1215134 | 01 | NE | MEDICARE | OTHER | 639314YQ33 | 01 | CO | MEDICARE | OTHER | 649869 | 01 | CO | MEDICARE | OTHER | NA1214133 | 01 | NE | MEDICARE | OTHER | NA2517110 | 01 | NE | MEDICARE | OTHER | 639314YQ3L | 01 | CO | MEDICARE | OTHER | 639314YQN9 | 01 | CO | MEDICARE | OTHER | 9000158871 | 05 | CO | MEDICAID | 639314YQPG | 01 | CO | MEDICARE | OTHER | 639314ZLJ3 | 01 | CO | MEDICARE | OTHER |