Provider Demographics
NPI:1508861832
Name:ENGLERT, THOMAS LEE (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:LEE
Last Name:ENGLERT
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 1:1627 E 18TH ST
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-4209
Mailing Address - Country:US
Mailing Address - Phone:970-663-0135
Mailing Address - Fax:970-461-1422
Practice Address - Street 1:1900 BOISE AVE
Practice Address - Street 2:STE 410
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-5004
Practice Address - Country:US
Practice Address - Phone:970-667-2009
Practice Address - Fax:970-667-2103
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO20740174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01207406Medicaid
CO04011672Medicaid
CO04011672Medicaid
COA52116Medicare UPIN
CO28631Medicare ID - Type Unspecified