Provider Demographics
NPI:1720495203
Name:MYTINGER, ANDREA KATHERINE (DO)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:KATHERINE
Last Name:MYTINGER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:274 UNION BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-1836
Mailing Address - Country:US
Mailing Address - Phone:303-951-0600
Mailing Address - Fax:303-951-0605
Practice Address - Street 1:274 UNION BLVD STE 110
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228
Practice Address - Country:US
Practice Address - Phone:303-951-0600
Practice Address - Fax:303-951-0605
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-17
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0065414207R00000X
NM390200000X
CODR.0065414207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease