Basic Information
| Provider Information | |||||||||
| NPI: | 1467436667 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PERTCHECK | ||||||||
| FirstName: | LAWRENCE | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1873 S BELLAIRE ST | ||||||||
| Address2: | SUITE 420 | ||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802224358 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037531191 | ||||||||
| FaxNumber: | 3037536636 | ||||||||
| Practice Location | |||||||||
| Address1: | 8300 W 38TH AVE | ||||||||
| Address2: | |||||||||
| City: | WHEAT RIDGE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800336005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034252015 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/01/2005 | ||||||||
| LastUpdateDate: | 04/05/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085B0100X | 18221 | CO | N | Allopathic & Osteopathic Physicians | Radiology | Body Imaging | 2085N0700X | 18221 | CO | N | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology | 2085N0904X | 18221 | CO | N | Allopathic & Osteopathic Physicians | Radiology | Nuclear Radiology | 2085P0229X | 18221 | CO | N | Allopathic & Osteopathic Physicians | Radiology | Pediatric Radiology | 2085R0202X | 18221 | CO | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0203X | 18221 | CO | N | Allopathic & Osteopathic Physicians | Radiology | Therapeutic Radiology | 2085R0204X | 18221 | CO | N | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology | 2085R0205X | 18221 | CO | N | Allopathic & Osteopathic Physicians | Radiology | Radiological Physics |
ID Information
| ID | Type | State | Issuer | Description | 01182211 | 05 | CO | MEDICAID |