Provider Demographics
NPI:1295715225
Name:DITTRICH, KARL PAUL (MD)
Entity type:Individual
Prefix:DR
First Name:KARL
Middle Name:PAUL
Last Name:DITTRICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:175 S UNION BLVD
Mailing Address - Street 2:SUITE 320
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80910-3113
Mailing Address - Country:US
Mailing Address - Phone:719-477-1033
Mailing Address - Fax:719-477-1037
Practice Address - Street 1:175 S UNION BLVD
Practice Address - Street 2:SUITE 320
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80910-3113
Practice Address - Country:US
Practice Address - Phone:719-477-1033
Practice Address - Fax:719-477-1037
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO385692086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO38677741Medicaid
COCN3248Medicare ID - Type Unspecified
CO38677741Medicaid
COCOA101011Medicare PIN