Organization
MEDICAL RTD INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TATYANA I DATKHAEVA MD (OWNER PHYSICIAN)
(720) 540-7155
Entity
Organization
Contact information
Practice address
7615 W 38TH AVE, UNIT B-123, WHEAT RIDGE, CO 80033-6172
(303) 432-2776
(303) 432-2216
Mailing address
7615 W 38TH AVE, UNIT B-123, WHEAT RIDGE, CO 80033
(720) 540-7155
(720) 540-7155
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
45108
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
45108
STATE LICENSE
CO
05
—
82709513
—
CO
Enumeration date
03/13/2007
Last updated
03/07/2023
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