MEDICARE: ZOE MARIE BOUCHELLE 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	208M00000X	Hospitalist Physician	DR.0070581	CO
2	208000000X	Pediatrics Physician	DR.0070581	CO
3	208000000X	Pediatrics Physician	MT213903	PA

General Provider Information

NPI Number	:	1922537778
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ZOE MARIE BOUCHELLE MD

Provider Business Mailing Address
First Line	:	777 BANNOCK ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80204-4507
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	777 BANNOCK ST
Second Line	:	DENVER HEALTH DEPARTMENT OF PEDIATRICS
City	:	DENVER
State	:	CO
Zip	:	80204-4507
Country	:	US
Telephone Number	:	410-960-3658
Fax Number	:

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

Provider Enumeration Date	:	06/06/2017
Last Update Date	:	06/15/2026

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