CZUCZMAN, GREGORY J (MD)

Provider Demographics

• NPI: 1245411958
• Name: CZUCZMAN, GREGORY J (MD)
• Entity Type: Individual
• Prefix: DR
• First Name: GREGORY
• Middle Name: J
• Last Name: CZUCZMAN
• Gender: M
• Credentials: MD
• Mailing Address - Street 1: 10800 E GEDDES AVE STE 300
• Mailing Address - City: ENGLEWOOD
• Mailing Address - State: CO
• Mailing Address - Zip Code: 80112-3895
• Mailing Address - Country: US
• Mailing Address - Phone: 303-761-9190
• Mailing Address - Fax: 720-874-4462
• Practice Address - Street 1: 10800 E GEDDES AVE STE 300
• Practice Address - City: ENGLEWOOD
• Practice Address - State: CO
• Practice Address - Zip Code: 80112-3895
• Practice Address - Country: US
• Practice Address - Phone: 303-761-9190
• Practice Address - Fax: 720-874-4462
• Is Sole Proprietor?: Yes
• Enumeration Date: 2007-11-21
• Last Update Date: 2022-12-09

Provider Licenses

State	License ID	Taxonomies
NE	29962	2085R0202X
MA	239318	2085R0202X
HI	MD19075	2085R0202X
KS	04-39909	2085R0202X
CO	52616	2085R0202X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization
Yes	2085R0202X	Allopathic & Osteopathic Physicians	Radiology	Diagnostic Radiology

Provider Identifiers

State	Identifier ID	ID Type	Issuer
CO	1245411958	Medicaid
CO	561677YQ33	Other	MEDICARE PIN
CO	561677YQN9	Other	MEDICARE PIN
CO	561677YQPG	Other	MEDICARE PIN
CO	561677ZLJ3	Other	MEDICARE PIN
NE	NA1214115	Other	MEDICARE PIN
KS	111257108	Other	MEDICARE PIN
KS	KA3249099	Other	MEDICARE PIN
NE	NA1215116	Other	MEDICARE PIN
CO	561677ZNTB	Other	MEDICARE PIN
NE	NA2517094	Other	MEDICARE PIN
CO	561677YQPG	Other	MEDICARE PIN
NE	$$$$$$$$$08	Medicaid
CO	561677YQ33	Other	MEDICARE PIN
KS	KA3249099	Other	MEDICARE PIN
NE	$$$$$$$$$00	Medicaid
NE	NA2517094	Other	MEDICARE PIN
NE	$$$$$$$$$05	Medicaid
NE	NA1214115	Other	MEDICARE PIN
NE	$$$$$$$$$03	Medicaid
CO	561677ZLJ3	Medicare PIN
CO	561677ZLJ3	Other	MEDICARE PIN
NE	$$$$$$$$$06	Medicaid
CO	561677YQPG	Medicare PIN
CO	561677YQPG	Other	MEDICARE PIN
NE	$$$$$$$$$01	Medicaid
NE	$$$$$$$$$03	Medicaid