Provider Demographics
NPI:1316032071
Name:GRUSHAN, MARC (MD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:
Last Name:GRUSHAN
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 1:2594 TRAILRIDGE DR E
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-3186
Mailing Address - Country:US
Mailing Address - Phone:303-449-7740
Mailing Address - Fax:
Practice Address - Street 1:2593 PARK LN
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-3172
Practice Address - Country:US
Practice Address - Phone:303-665-0115
Practice Address - Fax:303-415-3470
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO32743207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
COP00860038OtherRR MEDICARE
CO01327436Medicaid
COCOA100840Medicare PIN
COP00860038OtherRR MEDICARE
COC248478Medicare PIN