Provider Demographics
NPI:1619023231
Name:RANGOLE, ASHUTOSH SHYAM (MD)
Entity type:Individual
Prefix:DR
First Name:ASHUTOSH
Middle Name:SHYAM
Last Name:RANGOLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4900 S MONACO ST
Mailing Address - Street 2:#210
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-3486
Mailing Address - Country:US
Mailing Address - Phone:303-696-2131
Mailing Address - Fax:303-696-9151
Practice Address - Street 1:1421 S POTOMAC ST
Practice Address - Street 2:SUITE 330
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-4512
Practice Address - Country:US
Practice Address - Phone:303-696-2131
Practice Address - Fax:303-696-9151
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2011-07-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO46913207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO88557863Medicaid
COCO303680Medicare PIN
CO88557863Medicaid