Provider Demographics
NPI:1942434006
Name:CARRILLO, JODI MICHELLE (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:JODI
Middle Name:MICHELLE
Last Name:CARRILLO
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:DR
Other - First Name:JODI
Other - Middle Name:MICHELLE
Other - Last Name:THOMSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD, PHD
Mailing Address - Street 1:10350 E DAKOTA AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80247-1314
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1375 E 19TH AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1114
Practice Address - Country:US
Practice Address - Phone:303-338-4545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-05
Last Update Date:2021-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI60141207P00000X
CO0056362207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO027028OtherKAISER COMMERCIAL NUMBER
WI1942434006Medicaid
CO489192YK5YMedicare PIN
CO027028OtherKAISER COMMERCIAL NUMBER
WI1942434006Medicaid