Provider Demographics
NPI:1689449092
Name:PROHEALTH THERAPEUTICS
Entity Type:Organization
Organization Name:PROHEALTH THERAPEUTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PRADEEP
Authorized Official - Middle Name:
Authorized Official - Last Name:RAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:646-713-6033
Mailing Address - Street 1:2925 E COLFAX AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-1604
Mailing Address - Country:US
Mailing Address - Phone:303-209-5115
Mailing Address - Fax:833-603-0135
Practice Address - Street 1:4835 CENTENNIAL BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-3308
Practice Address - Country:US
Practice Address - Phone:646-713-6033
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-16
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory