Provider Demographics
NPI:1528364064
Name:LIRIO S. POLINTAN MD PC
Entity Type:Organization
Organization Name:LIRIO S. POLINTAN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LIRIO
Authorized Official - Middle Name:S
Authorized Official - Last Name:POLINTAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:719-545-0552
Mailing Address - Street 1:1600 N GRAND AVE STE 345
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81003-2762
Mailing Address - Country:US
Mailing Address - Phone:171-954-5055
Mailing Address - Fax:719-545-2945
Practice Address - Street 1:1600 N GRAND AVE STE 345
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-2762
Practice Address - Country:US
Practice Address - Phone:171-954-5055
Practice Address - Fax:719-545-2945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-01
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO24270207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01242700Medicaid
COA103943OtherPTAN
COC73191Medicare Oscar/Certification
COD24422Medicare UPIN