Provider Demographics
NPI:1649225749
Name:CHOWDHURY, KHALID (MD, MBA)
Entity type:Individual
Prefix:
First Name:KHALID
Middle Name:
Last Name:CHOWDHURY
Suffix:
Gender:M
Credentials:MD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 E 19TH AVE
Mailing Address - Street 2:SUITE 3000
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-1216
Mailing Address - Country:US
Mailing Address - Phone:303-839-5155
Mailing Address - Fax:303-839-5255
Practice Address - Street 1:1601 E 19TH AVE
Practice Address - Street 2:SUITE 3000
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1216
Practice Address - Country:US
Practice Address - Phone:303-839-5155
Practice Address - Fax:303-839-5255
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO35707207YX0007X, 207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
No207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01357078Medicaid
CO1649225749Medicare PIN
CO01357078Medicaid