Provider Demographics
NPI:1306928478
Name:RITTEL, LISA ROBIN (DO)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:ROBIN
Last Name:RITTEL
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 1:2885 AURORA AVENUE
Mailing Address - Street 2:SUITE 35
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303
Mailing Address - Country:US
Mailing Address - Phone:303-545-6500
Mailing Address - Fax:303-545-1770
Practice Address - Street 1:2885 AURORA AVENUE
Practice Address - Street 2:SUITE 35
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303
Practice Address - Country:US
Practice Address - Phone:303-545-6500
Practice Address - Fax:303-545-1770
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO33294204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01332949Medicaid
C76801Medicare UPIN
CO01332949Medicaid