Provider Demographics
NPI:1851352249
Name:HOONTRAKOON, RAWEEWAN (MD)
Entity Type:Individual
Prefix:
First Name:RAWEEWAN
Middle Name:
Last Name:HOONTRAKOON
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 1:5277 S BOSTON ST
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-3422
Mailing Address - Country:US
Mailing Address - Phone:303-520-3607
Mailing Address - Fax:
Practice Address - Street 1:19245 E SMOKY HILL RD UNIT A
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80015-3122
Practice Address - Country:US
Practice Address - Phone:719-345-1047
Practice Address - Fax:877-647-0202
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-28
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO39234207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
COG30557Medicare UPIN