Healthcare Provider Details

I. General information

NPI: 1518022938
Provider Name (Legal Business Name): GEORGE J JUETERSONKE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 01/21/2020
Certification Date: 01/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3525 AMERICAN DRIVE
COLORADO SPRINGS CO
80917
US

IV. Provider business mailing address

3525 AMERICAN DRIVE
COLORADO SPRINGS CO
80917
US

V. Phone/Fax

Practice location:
  • Phone: 719-597-6075
  • Fax: 719-573-6529
Mailing address:
  • Phone: 719-597-6075
  • Fax: 719-573-6529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number28685
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number28685
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number28685
License Number StateCO
# 4
Primary TaxonomyY
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number28685
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: