Provider Demographics
NPI:1144370545
Name:POTURALSKI, ANGELIQUE GENEVIEVE (MD)
Entity type:Individual
Prefix:DR
First Name:ANGELIQUE
Middle Name:GENEVIEVE
Last Name:POTURALSKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:7261 S BROADWAY
Mailing Address - Street 2:SUITE 101A
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80122-8017
Mailing Address - Country:US
Mailing Address - Phone:720-805-2366
Mailing Address - Fax:303-471-6066
Practice Address - Street 1:7261 S BROADWAY
Practice Address - Street 2:SUITE 101A
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80122-8017
Practice Address - Country:US
Practice Address - Phone:303-471-2466
Practice Address - Fax:303-471-6066
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO33806207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C73541Medicare ID - Type Unspecified
COG21848Medicare UPIN