Provider Demographics
NPI:1750743571
Name:BUSH, CHAD KENDALL (MD, MPH)
Entity type:Individual
Prefix:
First Name:CHAD
Middle Name:KENDALL
Last Name:BUSH
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 BANNOCK ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80204-4597
Mailing Address - Country:US
Mailing Address - Phone:303-436-4949
Mailing Address - Fax:303-602-6190
Practice Address - Street 1:777 BANNOCK ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-4597
Practice Address - Country:US
Practice Address - Phone:303-436-4949
Practice Address - Fax:303-602-6190
Is Sole Proprietor?:No
Enumeration Date:2016-03-22
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXU62092084N0400X, 2084N0400X
CODR.00629612084N0400X, 2084E0001X
FLME1625522084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084E0001XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyEpilepsy
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO62961OtherCOLORADO DEPARTMENT OF REGULATORY AGENCIES
CO62961OtherCOLORADO DEPARTMENT OF REGULATORY AGENCIES