Provider Demographics
NPI:1629423728
Name:FAZEL, NATASHA EILEEN (DO)
Entity type:Individual
Prefix:DR
First Name:NATASHA
Middle Name:EILEEN
Last Name:FAZEL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:NATASHA
Other - Middle Name:EILEEN
Other - Last Name:FAZEL-BOGORAD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:10350 E DAKOTA AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80247-1314
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2550 S PARKER RD
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-1622
Practice Address - Country:US
Practice Address - Phone:303-338-4545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-27
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0059292207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO029603OtherKAISER COMMERCIAL NUMBER
CO9000156160Medicaid