Provider Demographics
NPI:1114003399
Name:PAESCHKE, TRACY ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:ANN
Last Name:PAESCHKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:15954 JACKSON CREEK PKWY STE B
Mailing Address - Street 2:#435
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132-8532
Mailing Address - Country:US
Mailing Address - Phone:719-203-2603
Mailing Address - Fax:279-201-6476
Practice Address - Street 1:1633 MEDICAL CENTER POINT
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907
Practice Address - Country:US
Practice Address - Phone:719-203-2603
Practice Address - Fax:279-201-6476
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCDHR.0041162207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO11827238Medicaid
G77541Medicare UPIN
CO11827238Medicaid
COC493268Medicare PIN