Provider Demographics
NPI:1548282700
Name:PALES, DMITRIY I (DO)
Entity type:Individual
Prefix:
First Name:DMITRIY
Middle Name:I
Last Name:PALES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9395 CROWN CREST BLVD
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80138-8573
Mailing Address - Country:US
Mailing Address - Phone:303-643-0124
Mailing Address - Fax:
Practice Address - Street 1:13111 E BRIARWOOD AVE STE 370
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-3913
Practice Address - Country:US
Practice Address - Phone:720-441-4410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIDP014651207R00000X
CO46797207R00000X
CODR.0046797208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY1548282700Medicaid
MI4525551Medicaid
MI200000002506OtherPHP
MIP00054355OtherRAILROAD MEDICARE
CO22350314Medicaid
COP00645932Medicare PIN
C0300917Medicare PIN
MIP00054355OtherRAILROAD MEDICARE
MIH76395Medicare UPIN