Provider Demographics
NPI:1699060582
Name:STAHL, COSETTE M (DO)
Entity type:Individual
Prefix:DR
First Name:COSETTE
Middle Name:M
Last Name:STAHL
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 1:10800 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:2011-06-18
Last Update Date:2024-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR16562085R0204X
CODR.00598942085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NENA1214133OtherMEDICARE
CO9000158871Medicaid
CO639314YQ33OtherMEDICARE
CO639314YQN9OtherMEDICARE
NENA2517110OtherMEDICARE
CO639314ZLJ3OtherMEDICARE
NENA1215134OtherMEDICARE
CO639314YQ3LOtherMEDICARE
CO639314YQPGOtherMEDICARE
CO649869OtherMEDICARE