Basic Information
| Provider Information | |||||||||
| NPI: | 1598718652 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LUCHSINGER | ||||||||
| FirstName: | AMANDA | ||||||||
| MiddleName: | JANE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 555 PROSPECT AVE | ||||||||
| Address2: | |||||||||
| City: | ESTES PARK | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805176312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9705862200 | ||||||||
| FaxNumber: | 9705774536 | ||||||||
| Practice Location | |||||||||
| Address1: | 555 PROSPECT AVE | ||||||||
| Address2: | 7TH FLOOR | ||||||||
| City: | ESTES PARK | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805176312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9705862200 | ||||||||
| FaxNumber: | 9705774536 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2006 | ||||||||
| LastUpdateDate: | 04/21/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | ME69405 | FL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | DR47153 | CO | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 110129873 | 01 | FL | RAILROAD MEDICARE | OTHER | 24403580 | 05 | CO | MEDICAID | 251204100 | 05 | FL | MEDICAID |