Provider Demographics
NPI:1033166251
Name:SHUHERK, EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:SHUHERK
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 1:12790 W ALAMEDA PKWY
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-2859
Mailing Address - Country:US
Mailing Address - Phone:303-403-6350
Mailing Address - Fax:303-403-6372
Practice Address - Street 1:12790 W ALAMEDA PKWY
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-2859
Practice Address - Country:US
Practice Address - Phone:303-403-6350
Practice Address - Fax:303-403-6372
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAR7704207Q00000X
IA37303207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0469940Medicaid
IAP00741121OtherRR MEDICARE
IA1033166251Medicaid
IA71926054Medicare PIN