MEDICARE: DR. SUSAN BEAUSOLEIL BOGRAD 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	2084F0202X	Forensic Psychiatry Physician	34363	CO
2	2084P0800X	Psychiatry Physician	34363	CO

General Provider Information

NPI Number	:	1366517625
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN BEAUSOLEIL BOGRAD MD

Provider Business Mailing Address
First Line	:	3300 EAST FIRST AVENUE
Second Line	:	SUITE 590
City	:	DENVER
State	:	CO
Zip	:	80206-5818
Country	:	US
Telephone Number	:	303-320-1968
Fax Number	:	303-322-2155

Provider Business Practice Location Address
First Line	:	3300 EAST FIRST AVENUE
Second Line	:	SUITE 590
City	:	DENVER
State	:	CO
Zip	:	80206-5818
Country	:	US
Telephone Number	:	303-320-1968
Fax Number	:	303-322-2155

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

Provider Enumeration Date	:	11/22/2006
Last Update Date	:	09/11/2025

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