MEDICARE: OPTUM MEDICAL SERVICES OF COLORADO, P.C.

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	207QG0300X	Geriatric Medicine (Family Medicine) Physician

General Provider Information

NPI Number	:	1477943421
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPTUM MEDICAL SERVICES OF COLORADO, P.C.

Provider Business Mailing Address
First Line	:	13625 TECHNOLOGY DR
Second Line	:
City	:	EDEN PRAIRIE
State	:	MN
Zip	:	55344-2252
Country	:	US
Telephone Number	:	952-917-7982
Fax Number	:

Provider Business Practice Location Address
First Line	:	13625 TECHNOLOGY DR
Second Line	:
City	:	EDEN PRAIRIE
State	:	MN
Zip	:	55344-2252
Country	:	US
Telephone Number	:	952-917-7982
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. RONALD J SHUMACHER
Credential	:	M.D.
Telephone Number	:	240-683-5331

Provider Enumeration Date	:	01/29/2015
Last Update Date	:	01/29/2015

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