Provider Demographics
NPI:1255422739
Name:IRANI, KATAYUN (MD)
Entity type:Individual
Prefix:MISS
First Name:KATAYUN
Middle Name:
Last Name:IRANI
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 1:1721 EAST 19TH AVENUE
Mailing Address - Street 2:SUITE #404
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218
Mailing Address - Country:US
Mailing Address - Phone:303-861-9036
Mailing Address - Fax:303-861-4505
Practice Address - Street 1:1721 E 19TH AVE
Practice Address - Street 2:SUITE #404
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1251
Practice Address - Country:US
Practice Address - Phone:303-861-9036
Practice Address - Fax:303-861-4505
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2015-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0054758174400000X
NC174895208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
R154612Medicare PIN