Provider Demographics
NPI:1821046517
Name:BJORK, MICHAEL R (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:R
Last Name:BJORK
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:PO BOX 4337
Mailing Address - Street 2:
Mailing Address - City:WOODLAND PARK
Mailing Address - State:CO
Mailing Address - Zip Code:80866-4337
Mailing Address - Country:US
Mailing Address - Phone:719-687-3843
Mailing Address - Fax:
Practice Address - Street 1:41 STATE HIGHWAY 67
Practice Address - Street 2:
Practice Address - City:WOODLAND PARK
Practice Address - State:CO
Practice Address - Zip Code:80863-5008
Practice Address - Country:US
Practice Address - Phone:719-776-3216
Practice Address - Fax:719-776-3187
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO21503207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01215037Medicaid
COCOA109747Medicare PIN
CO080067649OtherRR MEDICARE
COCX0278Medicare PIN