Provider Demographics
NPI:1053317966
Name:YUSSMAN, MARTIN GLENN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:GLENN
Last Name:YUSSMAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:500 ELDORADO BLVD
Mailing Address - Street 2:SUITE 6250
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80021-3408
Mailing Address - Country:US
Mailing Address - Phone:303-272-0751
Mailing Address - Fax:303-318-2488
Practice Address - Street 1:1960 OGDEN ST STE 110
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-3667
Practice Address - Country:US
Practice Address - Phone:303-318-2460
Practice Address - Fax:303-318-2489
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2014-07-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO42537207RC0000X, 207UN0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO44472846Medicaid
CO300813Medicare PIN
COI03459Medicare UPIN