Provider Demographics
NPI:1558390252
Name:SAUERACKER, ANDREW J (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:J
Last Name:SAUERACKER
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 1:516 WILLOW VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:LAMAR
Mailing Address - State:CO
Mailing Address - Zip Code:81052-3918
Mailing Address - Country:US
Mailing Address - Phone:719-336-3894
Mailing Address - Fax:
Practice Address - Street 1:403 KENDALL DR
Practice Address - Street 2:SUITE 1500
Practice Address - City:LAMAR
Practice Address - State:CO
Practice Address - Zip Code:81052-3953
Practice Address - Country:US
Practice Address - Phone:719-336-7005
Practice Address - Fax:719-336-7012
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO27301208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01273010Medicaid
CO01273010Medicaid
L3108Medicare ID - Type Unspecified