Provider Demographics
NPI:1730134727
Name:BOGUSH, TAMARA L (MD)
Entity Type:Individual
Prefix:DR
First Name:TAMARA
Middle Name:L
Last Name:BOGUSH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TAMARA
Other - Middle Name:L
Other - Last Name:BIHUNIAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 110429
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80042-0429
Mailing Address - Country:US
Mailing Address - Phone:303-493-7000
Mailing Address - Fax:
Practice Address - Street 1:12605 E 16TH AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-2545
Practice Address - Country:US
Practice Address - Phone:720-848-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA057433207P00000X
CODR.0058619207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCG57433Medicaid
GA033273674DMedicaid
GA033273674AMedicaid
GA033273674BMedicaid
GA033273674CMedicaid
GA033273674Medicaid
SC033273674GMedicaid
GA10058557OtherAMERIGROUP
SCG57433Medicaid
SCI079408055Medicare PIN
GA93BFCDPMedicare PIN