Provider Demographics
NPI:1902980576
Name:SPOERKE, SUSAN ELIZABETH (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:ELIZABETH
Last Name:SPOERKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2428 WARD DR
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80215-1046
Mailing Address - Country:US
Mailing Address - Phone:303-237-6782
Mailing Address - Fax:
Practice Address - Street 1:8889 FOX DR
Practice Address - Street 2:SUITE A
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80260-8841
Practice Address - Country:US
Practice Address - Phone:303-430-0823
Practice Address - Fax:303-426-9581
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO25750208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01257500Medicaid
E46313Medicare UPIN