Provider Demographics
NPI:1982691440
Name:QUICKERT, TIMO M (MD)
Entity Type:Individual
Prefix:
First Name:TIMO
Middle Name:M
Last Name:QUICKERT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4848 THOMPSON PKWY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:JOHNSTOWN
Mailing Address - State:CO
Mailing Address - Zip Code:80534-6433
Mailing Address - Country:US
Mailing Address - Phone:970-800-4145
Mailing Address - Fax:
Practice Address - Street 1:4848 THOMPSON PKWY
Practice Address - Street 2:SUITE 300
Practice Address - City:JOHNSTOWN
Practice Address - State:CO
Practice Address - Zip Code:80534-6433
Practice Address - Country:US
Practice Address - Phone:970-800-4145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO455872085R0204X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO51579014Medicaid
CO51579014Medicaid