Provider Demographics
NPI:1013929660
Name:SHONKA, THOMAS E (DPM)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:E
Last Name:SHONKA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 28TH ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-1096
Mailing Address - Country:US
Mailing Address - Phone:303-449-2000
Mailing Address - Fax:303-449-9475
Practice Address - Street 1:1400 28TH ST
Practice Address - Street 2:SUITE 2
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-1096
Practice Address - Country:US
Practice Address - Phone:303-449-2000
Practice Address - Fax:303-449-9475
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCO335213EP1101X, 213ES0000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01003359Medicaid
CO841514106 03OtherPACIFICARE PROVIDER #
CO841514106 002OtherROCKY MNT HEALTH PLANS
COSH36054OtherBCBS PROVIDER #
CO841514106 03OtherPACIFICARE PROVIDER #
COT60234Medicare UPIN
CO01003359Medicaid
CO4126240001Medicare NSC
COCD5023Medicare PIN