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
StateLicense IDTaxonomies
CO34002207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01340025Medicaid
CO841547572003OtherROCKY MT HEALTH PLANS
CO2140494OtherAETNA- HMO
CO39677OtherBCBS
CO386628Medicare PIN
CO01340025Medicaid