MEDICARE: DR. MARTIN GLENN YUSSMAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	42537	CO
2	207UN0901X	Nuclear Cardiology Physician	42537	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053317966
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARTIN GLENN YUSSMAN M.D.

Provider Business Mailing Address
First Line	:	500 ELDORADO BLVD
Second Line	:	SUITE 6250
City	:	BROOMFIELD
State	:	CO
Zip	:	80021-3408
Country	:	US
Telephone Number	:	303-272-0751
Fax Number	:	303-318-2488

Provider Business Practice Location Address
First Line	:	1960 OGDEN ST STE 110
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80218-3667
Country	:	US
Telephone Number	:	303-318-2460
Fax Number	:	303-318-2489

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2005
Last Update Date	:	07/29/2014

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