Provider Demographics
NPI:1538165691
Name:FELIZ, ANTONIO PADILLA (MD)
Entity type:Individual
Prefix:
First Name:ANTONIO
Middle Name:PADILLA
Last Name:FELIZ
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3510 SAN JOSE CT
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81005-3916
Mailing Address - Country:US
Mailing Address - Phone:719-545-9713
Mailing Address - Fax:719-545-2054
Practice Address - Street 1:1925 E ORMAN AVE STE A340
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81004-3571
Practice Address - Country:US
Practice Address - Phone:719-569-7400
Practice Address - Fax:719-569-7338
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO37048174400000X, 208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01370485Medicaid
CO01370485Medicaid
CO01370485Medicaid
CO340017457OtherRAIL ROAD MEDICARE