Healthcare Provider Details

I. General information

NPI: 1659497261
Provider Name (Legal Business Name): LYDIA R BUCHMANN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 S PARKER RD STE 400
AURORA CO
80014-1677
US

IV. Provider business mailing address

2345 KEARNEY ST
DENVER CO
80207-3425
US

V. Phone/Fax

Practice location:
  • Phone: 303-636-2929
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number38341
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: