Provider Demographics
NPI:1619938859
Name:CHLADEK, PETRA (PAC)
Entity Type:Individual
Prefix:
First Name:PETRA
Middle Name:
Last Name:CHLADEK
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:940 CENTRAL PARK DR STE 210
Mailing Address - Street 2:
Mailing Address - City:STEAMBOAT SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80487-8853
Mailing Address - Country:US
Mailing Address - Phone:970-871-4811
Mailing Address - Fax:
Practice Address - Street 1:940 CENTRAL PARK DR STE 210
Practice Address - Street 2:
Practice Address - City:STEAMBOAT SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80487-8853
Practice Address - Country:US
Practice Address - Phone:970-871-4811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO61501743Medicaid
1359OtherCOLORADO STATE LICENSE
1359OtherCOLORADO STATE LICENSE
CO61501743Medicaid
COC804178Medicare PIN