Provider Demographics
NPI:1982639084
Name:NIEDERHUT, WILLIAM ERNEST (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:ERNEST
Last Name:NIEDERHUT
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 1:650 S CHERRY ST
Mailing Address - Street 2:SUITE 1060
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80246-1801
Mailing Address - Country:US
Mailing Address - Phone:303-331-0662
Mailing Address - Fax:303-377-3849
Practice Address - Street 1:650 S CHERRY ST
Practice Address - Street 2:SUITE 1060
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80246-1801
Practice Address - Country:US
Practice Address - Phone:303-331-0662
Practice Address - Fax:303-377-3849
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO264062084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01264068Medicaid
67651Medicare ID - Type Unspecified
D28386Medicare UPIN