Provider Demographics
NPI:1780609289
Name:SCHUCK, MICHAEL R (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:R
Last Name:SCHUCK
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 1:3920 N UNION BLVD
Mailing Address - Street 2:SUITE 330
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-4900
Mailing Address - Country:US
Mailing Address - Phone:719-570-7272
Mailing Address - Fax:719-570-9030
Practice Address - Street 1:3920 N UNION BLVD
Practice Address - Street 2:SUITE 330
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-4900
Practice Address - Country:US
Practice Address - Phone:719-570-7272
Practice Address - Fax:719-570-9030
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101243241207X00000X
CO47402207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
COP00750756OtherRR MEDICARE
TX160128802Medicaid
TXP00092584OtherPALMETTO GBA-RAILROAD
COP00750756OtherRR MEDICARE
TX8B2983Medicare ID - Type Unspecified