MEDICARE: SHANE AUGUST JUENEMANN M.D.

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	207Q00000X	Family Medicine Physician	42518	CO

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	:	1437138369
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANE AUGUST JUENEMANN M.D.

Provider Business Mailing Address
First Line	:	5450 WESTERN AVE
Second Line	:	SUITE B
City	:	BOULDER
State	:	CO
Zip	:	80301-2709
Country	:	US
Telephone Number	:	303-415-7599
Fax Number	:	303-530-5474

Provider Business Practice Location Address
First Line	:	6685 GUNPARK DR STE 110
Second Line	:
City	:	BOULDER
State	:	CO
Zip	:	80301-3343
Country	:	US
Telephone Number	:	303-530-3062
Fax Number	:	303-530-5474

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

Provider Enumeration Date	:	01/10/2006
Last Update Date	:	11/09/2017

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