Provider Demographics
NPI:1730155490
Name:HRUSKA, KEITH ANTHONY JR (MD)
Entity type:Individual
Prefix:DR
First Name:KEITH
Middle Name:ANTHONY
Last Name:HRUSKA
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 S DOWNING ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-5817
Mailing Address - Country:US
Mailing Address - Phone:303-715-7184
Mailing Address - Fax:303-874-5886
Practice Address - Street 1:2525 S DOWNING ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-5817
Practice Address - Country:US
Practice Address - Phone:303-715-7184
Practice Address - Fax:303-765-6228
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2016-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003002293207R00000X, 208M00000X
CODR.0046160207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00281322OtherRAILROAD MEDICARE
MO206011314Medicaid
CO71403736Medicaid
COP01547594OtherMEDICARE RAILROAD
CO434233YMMWMedicare PIN
P00281322OtherRAILROAD MEDICARE
CO434233YJTEMedicare PIN
MO918873117Medicare PIN
CO434233YLTTMedicare PIN