Provider Demographics
NPI:1730194531
Name:NATANAWAN, EMERITO (MD)
Entity type:Individual
Prefix:
First Name:EMERITO
Middle Name:
Last Name:NATANAWAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6767 W 29TH STREET
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-5474
Mailing Address - Country:US
Mailing Address - Phone:970-652-2433
Mailing Address - Fax:970-652-2252
Practice Address - Street 1:6767 W 29TH STREET
Practice Address - Street 2:2ND FLOOR
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-5474
Practice Address - Country:US
Practice Address - Phone:970-652-2433
Practice Address - Fax:970-652-2252
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-091850207R00000X
COCDR.0001214207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILG25909Medicare UPIN