Provider Demographics
NPI:1376673574
Name:SCHEUER, KIM (MD)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:SCHEUER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12325 COYOTE VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:SALIDA
Mailing Address - State:CO
Mailing Address - Zip Code:81201-9334
Mailing Address - Country:US
Mailing Address - Phone:970-309-8528
Mailing Address - Fax:833-371-1490
Practice Address - Street 1:12325 COYOTE VALLEY RD
Practice Address - Street 2:
Practice Address - City:SALIDA
Practice Address - State:CO
Practice Address - Zip Code:81201-9334
Practice Address - Country:US
Practice Address - Phone:970-309-8528
Practice Address - Fax:833-371-1490
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCDRH36252207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
J5348Medicare ID - Type Unspecified
G60733Medicare UPIN