Provider Demographics
NPI:1760515464
Name:HUIZAR, ISHAM A (MD)
Entity type:Individual
Prefix:
First Name:ISHAM
Middle Name:A
Last Name:HUIZAR
Suffix:
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 1:7100 E BELLEVIEW AVE STE G10
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-1634
Mailing Address - Country:US
Mailing Address - Phone:303-745-0000
Mailing Address - Fax:303-773-3675
Practice Address - Street 1:7100 E BELLEVIEW AVE STE G10
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-1634
Practice Address - Country:US
Practice Address - Phone:303-745-0000
Practice Address - Fax:303-773-3675
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCDRH.0059734207RC0200X, 207RP1001X
NC2009-00018207R00000X, 207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC151W2OtherBCBSNC
NCP00835184OtherMEDICARE RAILROAD - 0322 GROUP
NC5911036Medicaid
NC2023436Medicare PIN