Provider Demographics
NPI:1366468902
Name:SHEBOWICH, JOEL (MD)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:
Last Name:SHEBOWICH
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 1:13111 E BRIARWOOD AVE STE 215
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-3846
Mailing Address - Country:US
Mailing Address - Phone:303-680-9150
Mailing Address - Fax:303-680-9149
Practice Address - Street 1:13111 E BRIARWOOD AVE STE 215
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-3846
Practice Address - Country:US
Practice Address - Phone:303-680-9150
Practice Address - Fax:303-680-9149
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO29860207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01298603Medicaid
CO01298603Medicaid
COC471158Medicare ID - Type Unspecified