Provider Demographics
NPI:1952390874
Name:HERLEVICH, JOHN C JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:C
Last Name:HERLEVICH
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:8400 ALCOTT ST
Mailing Address - Street 2:#103
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80031-3817
Mailing Address - Country:US
Mailing Address - Phone:303-428-9608
Mailing Address - Fax:303-428-9638
Practice Address - Street 1:8400 ALCOTT ST
Practice Address - Street 2:#103
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80031-3817
Practice Address - Country:US
Practice Address - Phone:303-428-9608
Practice Address - Fax:303-428-9638
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
CO24575207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1245752Medicaid
CO1245752Medicaid