Healthcare Provider Details

I. General information

NPI: 1982691440
Provider Name (Legal Business Name): TIMO M QUICKERT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2005
Last Update Date: 12/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4848 THOMPSON PKWY SUITE 300
JOHNSTOWN CO
80534-6433
US

IV. Provider business mailing address

4848 THOMPSON PKWY SUITE 300
JOHNSTOWN CO
80534-6433
US

V. Phone/Fax

Practice location:
  • Phone: 970-800-4145
  • Fax:
Mailing address:
  • Phone: 970-800-4145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number45587
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: