Provider Demographics
NPI:1033219878
Name:SHUKERT, BENJAMIN (MD)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:SHUKERT
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 1:5200 DTC PKWY
Mailing Address - Street 2:SUITE 400
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-2719
Mailing Address - Country:US
Mailing Address - Phone:303-745-0000
Mailing Address - Fax:303-708-1834
Practice Address - Street 1:5200 DTC PKWY
Practice Address - Street 2:SUITE 400
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-2719
Practice Address - Country:US
Practice Address - Phone:303-745-0000
Practice Address - Fax:303-708-1834
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO39715207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO58205250Medicaid
COH51582Medicare UPIN
COC447838Medicare PIN