Provider Demographics
NPI:1205088507
Name:SITOLE, SUMIT (MD)
Entity type:Individual
Prefix:
First Name:SUMIT
Middle Name:
Last Name:SITOLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5245 SKYTRAIL DR
Mailing Address - Street 2:
Mailing Address - City:BOW MAR
Mailing Address - State:CO
Mailing Address - Zip Code:80123-1566
Mailing Address - Country:US
Mailing Address - Phone:617-320-0321
Mailing Address - Fax:
Practice Address - Street 1:55 MADISON ST
Practice Address - Street 2:355
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-5419
Practice Address - Country:US
Practice Address - Phone:303-377-2020
Practice Address - Fax:303-388-0606
Is Sole Proprietor?:No
Enumeration Date:2008-10-17
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD67988207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO49102OtherMEDICAL LICENSE
CO84034785Medicaid
CO84034785Medicaid