Provider Demographics
NPI:1154315976
Name:BUCHHOLZ, TROY K (MD)
Entity Type:Individual
Prefix:
First Name:TROY
Middle Name:K
Last Name:BUCHHOLZ
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 1:1455 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CO
Mailing Address - Zip Code:80550-5559
Mailing Address - Country:US
Mailing Address - Phone:970-686-3950
Mailing Address - Fax:970-686-3960
Practice Address - Street 1:1455 MAIN ST
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CO
Practice Address - Zip Code:80550-5559
Practice Address - Country:US
Practice Address - Phone:970-686-3950
Practice Address - Fax:970-686-3960
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA34212207Q00000X
CODR.0068519207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA4213967Medicaid
I17912OtherMEDICARE PART B
IA34674OtherWELLMARK BCBS
IAH48483Medicare UPIN