Provider Demographics
NPI:1588755623
Name:STRATIL, PETER GABRIEL (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:GABRIEL
Last Name:STRATIL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10800 E GEDDES AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80112-3895
Mailing Address - Country:US
Mailing Address - Phone:303-761-9190
Mailing Address - Fax:720-874-4462
Practice Address - Street 1:10800 E GEDDES AVE STE 300
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80112-3895
Practice Address - Country:US
Practice Address - Phone:303-761-9190
Practice Address - Fax:720-874-4462
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2024-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAML200086272085R0202X
KS04-363202085R0202X
HIMD176342085R0202X
NE261062085R0202X
CODR.00496552085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM83375031Medicaid
WY1588755623Medicaid
KS200876250AMedicaid
NE10026133600Medicaid
SD1588755623Medicaid
CO67959075Medicaid
CO392494ZLJ3Medicare PIN
KS200876250AMedicaid
NM83375031Medicaid
NE10026133600Medicaid
SD1588755623Medicaid
COP01019383Medicare PIN
COCOAAA1556Medicare PIN
CO67959075Medicaid
NENA1215068Medicare PIN
COP01029650Medicare PIN
KSKA3249003Medicare PIN
COP01019362Medicare PIN
NEP01021368Medicare PIN
COCOAAA1553Medicare PIN