Provider Demographics
NPI:1295916088
Name:CLEVELAND, ANDREW T (PA-C)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:T
Last Name:CLEVELAND
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1830 FRANKLIN ST
Mailing Address - Street 2:SUITE 450
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-1128
Mailing Address - Country:US
Mailing Address - Phone:303-321-1333
Mailing Address - Fax:303-321-0620
Practice Address - Street 1:1830 FRANKLIN ST
Practice Address - Street 2:SUITE 450
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1128
Practice Address - Country:US
Practice Address - Phone:303-321-1333
Practice Address - Fax:303-321-0620
Is Sole Proprietor?:No
Enumeration Date:2007-11-20
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2540363AS0400X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04403819Medicaid
CO04013215Medicaid
COCOA102689Medicare PIN
CO04013215Medicaid