MEDICARE: SUSAN BOACKLE CHILDRESS MD

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	207RR0500X	Rheumatology Physician	70477	AZ
2	207RR0500X	Rheumatology Physician	CDRH.0035598	CO
3	207RR0500X	Rheumatology Physician	MD.43902	AL
4	207RR0500X	Rheumatology Physician	335634	LA
5	207RR0500X	Rheumatology Physician	MD28095	ME
6	207RR0500X	Rheumatology Physician	H7909	TX

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	:	1235229915
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN BOACKLE CHILDRESS MD

Provider Business Mailing Address
First Line	:	2459 S CHASE LN
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80227-3902
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3601 S PENNSYLVANIA ST STE B
Second Line	:
City	:	ENGLEWOOD
State	:	CO
Zip	:	80113-3753
Country	:	US
Telephone Number	:	720-262-2462
Fax Number	:

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

Provider Enumeration Date	:	10/13/2006
Last Update Date	:	01/25/2026

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Directions to “ SUSAN BOACKLE CHILDRESS MD” Practice Location

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