Provider Demographics
NPI:1295782480
Name:HUYETTE, DAVID ROBERT (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:ROBERT
Last Name:HUYETTE
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 1:36 GARDEN CTR
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-1730
Mailing Address - Country:US
Mailing Address - Phone:303-465-0401
Mailing Address - Fax:303-404-2317
Practice Address - Street 1:1 SAINT ANTHONYS WAY
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-4568
Practice Address - Country:US
Practice Address - Phone:618-465-4520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA364772085R0202X
IL0361186522085R0202X
MO20030033922085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL4399003OtherMEDICARE
IL$$$$$$$$$-3Medicaid
IL$$$$$$$$$Medicaid
MO152360049Medicare PIN
IL$$$$$$$$$-3Medicaid
I49571Medicare UPIN