Provider Demographics
NPI:1073769790
Name:HUSA, RUCHIKA DUTTA (MD)
Entity Type:Individual
Prefix:DR
First Name:RUCHIKA
Middle Name:DUTTA
Last Name:HUSA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:RUCHIKA
Other - Middle Name:
Other - Last Name:DUTTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:8300 ALCOTT STREET
Mailing Address - Street 2:SCLHS
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80031-1252
Mailing Address - Country:US
Mailing Address - Phone:303-603-9976
Mailing Address - Fax:303-403-6213
Practice Address - Street 1:1400 JACKSON ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-2761
Practice Address - Country:US
Practice Address - Phone:303-398-1528
Practice Address - Fax:303-270-2174
Is Sole Proprietor?:No
Enumeration Date:2008-08-13
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.099323207RC0000X
CAA104673207R00000X
CO56601207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO54750164Medicaid
CO4880892LEWMedicare PIN
OHPENDINGMedicare PIN