Provider Demographics
NPI:1487662805
Name:WALSHAK, ANDREW L
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:L
Last Name:WALSHAK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ANDREW
Other - Middle Name:
Other - Last Name:WALSHAK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 173862
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80217-3862
Mailing Address - Country:US
Mailing Address - Phone:303-306-7783
Mailing Address - Fax:303-306-7753
Practice Address - Street 1:9191 GRANT ST.
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80229-8812
Practice Address - Country:US
Practice Address - Phone:303-450-4482
Practice Address - Fax:303-306-7753
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT039070207PE0004X
CODR.0053309207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
COP01384974OtherRAILROAD MEDICARE
CO18480543Medicaid
CO348682YL2GMedicare PIN
COP01384974OtherRAILROAD MEDICARE