Provider Demographics
NPI:1639233919
Name:UTLAUT, NILES F (MD)
Entity Type:Individual
Prefix:DR
First Name:NILES
Middle Name:F
Last Name:UTLAUT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1155 ALPINE AVE
Mailing Address - Street 2:STE 270
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-3495
Mailing Address - Country:US
Mailing Address - Phone:303-440-5033
Mailing Address - Fax:303-440-0889
Practice Address - Street 1:1155 ALPINE AVE
Practice Address - Street 2:STE 270
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-3495
Practice Address - Country:US
Practice Address - Phone:303-440-5033
Practice Address - Fax:303-440-0889
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO22970207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04011409Medicaid
CO04011409Medicaid
COC91731Medicare PIN