Provider Demographics
NPI:1437115409
Name:POLINTAN, LIRIO S (MD)
Entity Type:Individual
Prefix:
First Name:LIRIO
Middle Name:S
Last Name:POLINTAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 560825
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80256-0825
Mailing Address - Country:US
Mailing Address - Phone:719-595-7580
Mailing Address - Fax:719-545-0176
Practice Address - Street 1:1600 N GRAND
Practice Address - Street 2:SUITE 150
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-2749
Practice Address - Country:US
Practice Address - Phone:719-595-7680
Practice Address - Fax:719-595-7687
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2017-03-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO24270207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
COA103944OtherPTAN
CO01242700Medicaid
COD24422Medicare UPIN
COC73191Medicare Oscar/Certification