Provider Demographics
NPI:1437299468
Name:MISTRY, DILAAWAR J (MD)
Entity Type:Individual
Prefix:
First Name:DILAAWAR
Middle Name:J
Last Name:MISTRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001A E HARMONY RD # 181
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-3354
Mailing Address - Country:US
Mailing Address - Phone:434-760-1473
Mailing Address - Fax:
Practice Address - Street 1:2021 BATTLECREEK DR UNIT A
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80528-5120
Practice Address - Country:US
Practice Address - Phone:883-992-2742
Practice Address - Fax:970-557-2326
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101233275208100000X
CO49953207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO88032779Medicaid
VA006800904Medicaid
VAH68915Medicare UPIN