Basic Information
| Provider Information | |||||||||
| NPI: | 1780609289 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SCHUCK | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | R. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3920 N UNION BLVD | ||||||||
| Address2: | SUITE 330 | ||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809074900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195707272 | ||||||||
| FaxNumber: | 7195709030 | ||||||||
| Practice Location | |||||||||
| Address1: | 3920 N UNION BLVD | ||||||||
| Address2: | SUITE 330 | ||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809074900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195707272 | ||||||||
| FaxNumber: | 7195709030 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2006 | ||||||||
| LastUpdateDate: | 10/26/2009 | ||||||||
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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 | 207X00000X | 0101243241 | VA | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | 47402 | CO | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | P00750756 | 01 | CO | RR MEDICARE | OTHER | 160128802 | 05 | TX | MEDICAID | P00092584 | 01 | TX | PALMETTO GBA-RAILROAD | OTHER |