Provider Demographics
NPI:1457305443
Name:SUELTO, IMELDA (MD)
Entity Type:Individual
Prefix:
First Name:IMELDA
Middle Name:
Last Name:SUELTO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MELODY
Other - Middle Name:
Other - Last Name:SUELTO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 76510
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80970-6510
Mailing Address - Country:US
Mailing Address - Phone:719-663-8884
Mailing Address - Fax:
Practice Address - Street 1:2460 OAK HILLS DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-3474
Practice Address - Country:US
Practice Address - Phone:719-661-9441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COME38870207LP2900X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO013437062Medicaid
CO388738OtherANTHEM/BLUE CROSS
CO050083513OtherRAILROAD MEDICARE
CO050083513OtherRAILROAD MEDICARE
COG48501Medicare UPIN
COC808230Medicare PIN