Provider Demographics
NPI:1245336312
Name:HUZICKA, IGOR (MD)
Entity type:Individual
Prefix:DR
First Name:IGOR
Middle Name:
Last Name:HUZICKA
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 6380
Mailing Address - Street 2:
Mailing Address - City:VAIL
Mailing Address - State:CO
Mailing Address - Zip Code:81658-6380
Mailing Address - Country:US
Mailing Address - Phone:303-330-4301
Mailing Address - Fax:
Practice Address - Street 1:570 STONE CREEK DR
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:CO
Practice Address - Zip Code:81620-5663
Practice Address - Country:US
Practice Address - Phone:720-441-4305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO45014207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO45014OtherSTATE LICENSE
CO62257234Medicaid
CO62257234Medicaid
CO806944Medicare PIN