Provider Demographics
NPI:1982665568
Name:EDRICH, ANDREAS J (MD)
Entity Type:Individual
Prefix:
First Name:ANDREAS
Middle Name:J
Last Name:EDRICH
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 1:9218 KIMMER DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-6732
Mailing Address - Country:US
Mailing Address - Phone:303-332-6529
Mailing Address - Fax:303-792-3361
Practice Address - Street 1:9218 KIMMER DR
Practice Address - Street 2:
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-6733
Practice Address - Country:US
Practice Address - Phone:303-792-3333
Practice Address - Fax:303-792-3361
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCO37249207Q00000X
CO37249207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO28230779Medicaid
CO468178Medicare PIN
CO484958Medicare PIN
CO28230779Medicaid