Provider Demographics
NPI:1336186022
Name:LUETHKE, JAMES (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:LUETHKE
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 1:10700 E GEDDES AVE
Mailing Address - Street 2:NO 200
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80112-3800
Mailing Address - Country:US
Mailing Address - Phone:303-761-9190
Mailing Address - Fax:720-874-4462
Practice Address - Street 1:501 E HAMPDEN AVE
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-2702
Practice Address - Country:US
Practice Address - Phone:303-761-9190
Practice Address - Fax:720-874-4462
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO283432085R0202X
NE251412085R0202X
KS04-367082085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01283431Medicaid
OK200025590AMedicaid
NE10025709000Medicaid
WY1336186022Medicaid
CO300050302OtherRR RIA MEDICARE
MT1336186022Medicaid
SD1336186022Medicaid
CO300090472OtherRR MIC MEDICARE
IA1336186022Medicaid
NE84-059792913Medicaid
MI104686258Medicaid
CA1336186022Medicaid
KS200254510AMedicaid
NM36206873Medicaid
AZ908376Medicaid
COCO305857Medicare PIN
KS111257060Medicare PIN
WY1336186022Medicaid
MT1336186022Medicaid
NE10025709000Medicaid
IA1336186022Medicaid
NENA1214045Medicare PIN
COE83398Medicare UPIN
KSKA3249047Medicare PIN
COC211698Medicare PIN
COCW4228Medicare PIN
CA1336186022Medicaid