Provider Demographics
NPI:1053714584
Name:PRO HEALTH ONE INC
Entity type:Organization
Organization Name:PRO HEALTH ONE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PRADEEP
Authorized Official - Middle Name:R
Authorized Official - Last Name:RAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:646-713-6033
Mailing Address - Street 1:8181 E TUFTS AVE STE 560
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-2559
Mailing Address - Country:US
Mailing Address - Phone:866-782-8393
Mailing Address - Fax:888-972-8596
Practice Address - Street 1:8181 E TUFTS AVE STE 560
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80237-2559
Practice Address - Country:US
Practice Address - Phone:866-782-8393
Practice Address - Fax:888-972-8596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-29
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
H441380Medicare PIN