Provider Demographics
NPI:1508812629
Name:PILLEN, TODD J (PA-C)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:J
Last Name:PILLEN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2535 S DOWNING ST
Mailing Address - Street 2:SUITE 380
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-5847
Mailing Address - Country:US
Mailing Address - Phone:303-778-5797
Mailing Address - Fax:303-778-5205
Practice Address - Street 1:2535 S DOWNING ST
Practice Address - Street 2:SUITE 380
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-5847
Practice Address - Country:US
Practice Address - Phone:303-778-5797
Practice Address - Fax:303-778-5205
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA29402086S0120X
TXPA06207363AS0400X, 2086S0120X
COPA.0003886363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX098802401Medicaid