Provider Demographics
NPI: | 1669479549 |
---|---|
Name: | STELMACH, LAWRENCE JOSEPH (MD) |
Entity Type: | Individual |
Prefix: | |
First Name: | LAWRENCE |
Middle Name: | JOSEPH |
Last Name: | STELMACH |
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: | 3225 I-70 BUSINESS LOOP |
Mailing Address - Street 2: | STE A4 |
Mailing Address - City: | CLIFTON |
Mailing Address - State: | CO |
Mailing Address - Zip Code: | 81520-7687 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 970-434-6542 |
Mailing Address - Fax: | 970-434-3327 |
Practice Address - Street 1: | 3225 I-70 BUSINESS LOOP |
Practice Address - Street 2: | STE A4 |
Practice Address - City: | CLIFTON |
Practice Address - State: | CO |
Practice Address - Zip Code: | 81520-7687 |
Practice Address - Country: | US |
Practice Address - Phone: | 970-434-6542 |
Practice Address - Fax: | 970-434-3327 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2005-07-07 |
Last Update Date: | 2010-06-25 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CO | 34002 | 207Q00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
CO | 01340025 | Medicaid | |
CO | 841547572003 | Other | ROCKY MT HEALTH PLANS |
CO | 2140494 | Other | AETNA- HMO |
CO | 39677 | Other | BCBS |
CO | 386628 | Medicare PIN | |
CO | 01340025 | Medicaid |