Provider Demographics
NPI:1811422702
Name:KUSTER, SHAW (MD)
Entity type:Individual
Prefix:
First Name:SHAW
Middle Name:
Last Name:KUSTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHAW
Other - Middle Name:
Other - Last Name:VONDER HOYA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:315 W SOUTH BOULDER RD STE 206
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-1157
Mailing Address - Country:US
Mailing Address - Phone:720-585-3250
Mailing Address - Fax:
Practice Address - Street 1:315 W SOUTH BOULDER RD STE 206
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-1157
Practice Address - Country:US
Practice Address - Phone:720-585-3250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-27
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO67136207Q00000X
TX1204821469X207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine