Provider Demographics
NPI:1790005122
Name:KHALSA, HARI (MD)
Entity Type:Individual
Prefix:
First Name:HARI
Middle Name:
Last Name:KHALSA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5788
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80217-5788
Mailing Address - Country:US
Mailing Address - Phone:607-351-5955
Mailing Address - Fax:
Practice Address - Street 1:550 S WADSWORTH BLVD UNIT 410
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226-3118
Practice Address - Country:US
Practice Address - Phone:303-202-1280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-08
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO54611207P00000X
MN61699207P00000X
PAMD448411207P00000X
IL036152781207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO391565YLQEMedicare PIN