Provider Demographics
NPI:1033188917
Name:GIARRATANO, ANGELO SAM (DPM)
Entity Type:Individual
Prefix:DR
First Name:ANGELO
Middle Name:SAM
Last Name:GIARRATANO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2037 JERRY MURPHY RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81001-1256
Mailing Address - Country:US
Mailing Address - Phone:719-544-6505
Mailing Address - Fax:719-546-8644
Practice Address - Street 1:2037 JERRY MURPHY RD
Practice Address - Street 2:SUITE 100
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81001-1256
Practice Address - Country:US
Practice Address - Phone:719-544-6505
Practice Address - Fax:719-546-8644
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2010-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO304213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
51963OtherBCBS
480033178OtherRAILROAD MEDICARE
51963OtherBCBS
480033178OtherRAILROAD MEDICARE
CO0360130001Medicare NSC