Provider Demographics
NPI:1003895293
Name:BACH, IAN SEBASTIAN (MD)
Entity Type:Individual
Prefix:
First Name:IAN
Middle Name:SEBASTIAN
Last Name:BACH
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 1:2695 ROCKY MOUNTAIN AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-9071
Mailing Address - Country:US
Mailing Address - Phone:970-624-4123
Mailing Address - Fax:970-624-2416
Practice Address - Street 1:19964 HILLTOP RD STE A
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-7316
Practice Address - Country:US
Practice Address - Phone:303-841-2212
Practice Address - Fax:303-841-4716
Is Sole Proprietor?:No
Enumeration Date:2006-01-16
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO35490207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01354901Medicaid
CO04020541Medicaid
CO276029OtherCIGNA
CO84136530238OtherPACIFICARE
CO7201056OtherAETNA
CORO103008OtherGROUP ANTHEM BCBS
CO84136530263OtherPACIFICARE PPO
CO080186089OtherRAILROAD MEDICARE #
COBA645053OtherANTHEM BCBS
CO1003895293OtherNPI #
CO1215981634OtherGROUP NPI #
CO841365302036OtherRKY MTN HMO
CO841365302036OtherRKY MTN HMO
CO84136530238OtherPACIFICARE
CO080186089OtherRAILROAD MEDICARE #