Provider Demographics
NPI:1245290089
Name:HUHTA, BRADLEY D (MD FACC)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:D
Last Name:HUHTA
Suffix:
Gender:M
Credentials:MD FACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 N MESA AVE
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401-3902
Mailing Address - Country:US
Mailing Address - Phone:970-252-1020
Mailing Address - Fax:970-252-1041
Practice Address - Street 1:17 N MESA AVE
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-3902
Practice Address - Country:US
Practice Address - Phone:970-252-1020
Practice Address - Fax:970-252-1041
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO35336207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01353366Medicaid
CO35336OtherSTATE OF COLORADO LICENSE
BH3076848OtherUS DEPT OF JUSTICE DEA
CO01353366Medicaid
CO35336OtherSTATE OF COLORADO LICENSE
CO201418Medicare ID - Type Unspecified