Provider Demographics
NPI:1467127985
Name:HEARTISTIC COLORADO LLC
Entity Type:Organization
Organization Name:HEARTISTIC COLORADO LLC
Other - Org Name:CHERRY CREEK HEART
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FOUNDING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAYAL
Authorized Official - Middle Name:
Authorized Official - Last Name:KOHLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:646-944-2323
Mailing Address - Street 1:450 UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-4126
Mailing Address - Country:US
Mailing Address - Phone:617-763-3827
Mailing Address - Fax:833-916-2265
Practice Address - Street 1:1411 S POTOMAC ST STE 190
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-4542
Practice Address - Country:US
Practice Address - Phone:646-944-2323
Practice Address - Fax:833-916-2265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-16
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO56733844Medicaid