Provider Demographics
NPI:1205987583
Name:HULETT, CHRISTIAN G (MD)
Entity type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:G
Last Name:HULETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:9014 CASCADE AVE
Mailing Address - Street 2:
Mailing Address - City:BEULAH
Mailing Address - State:CO
Mailing Address - Zip Code:81023-9745
Mailing Address - Country:US
Mailing Address - Phone:719-564-0450
Mailing Address - Fax:719-564-1659
Practice Address - Street 1:1925 E ORMAN AVE
Practice Address - Street 2:SUITE A535
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81004-3537
Practice Address - Country:US
Practice Address - Phone:719-564-0450
Practice Address - Fax:719-564-1659
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO36704207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01367044Medicaid
CO01367044Medicaid
CO110199917Medicare PIN
F29717Medicare UPIN