Michael Todd Duzan, DO
Individual provider Active NPI Family Medicine Physician · Pueblo, CO
NPI 1124086723 · NPPES record last updated Oct 29, 2019
Key facts
- NPI
- 1124086723
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- DR.0063273 (CO)
- Practice address
- 401 W Northern Ave
Pueblo, CO 81004-3111 - Phone
- (719) 553-0400
- Fax
- (719) 553-0401
- NPI assigned
- May 3, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 12
Hospital & facility affiliations 5
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- At Still University of Health Sciences, College of Osteo Med, Kirksville, 1991
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Scotland County Memorial Hospital
Practice addresses (Care Compare)
450 E Sigler Ave
Memphis, MO 63555-1726
Phone (660) 465-2828
Hospital & facility affiliations
- Hospice of Northeast Missouri
- Scotland County Hospital
- Northeast Regional Medical Center
- Kirksville Manor Care Center
- Clark County Nursing Home
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20031126000150 | MO | Practitioner - Family Practice |
2860396280 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 105506 | MO | MD | Emergency Medicine Physician |
| DR.0063273 | CO | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Scotland County Memorial Hospital | Family Medicine | Current |
Accepting new patients |
| Scotland County Memorial Hospital | Family Medicine | Current |
Accepting new patients |
| Scotland County Memorial Hospital | Current |
Accepting new patients | |
| Kirksville Missouri Hospital Company LLC | Past | Accepting new patients | |
| Scotland County Memorial Hospital | Family Medicine | Past | Accepting new patients |
| Scotland County Memorial Hospital | Family Medicine | Past |
Accepting new patients |
| Scotland County Memorial Hosptial | Past | Accepting new patients | |
| Emcare Physician Providers, Inc. | Emergency Medicine | Past | Accepting new patients |
| Carthage Emergency Physicians LLC | Emergency Medicine | Past | Accepting new patients |
Locations
55682 State Highway 6
Ste A
Edina, MO 63537
Phone (660) 460-8140
450 E Sigler Ave
Ste A
Memphis, MO 63555
Phone (660) 465-2828
450 E Sigler Ave
Memphis, MO 63555
Phone (660) 465-2828
11024 Jefferson St
Wyaconda, MO 63474
Phone (660) 479-5553
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | 105506 | MO | |
| Family Medicine Physician | 207Q00000X | 105506 | MO | |
| Family Medicine Physician | 207Q00000X | DR.0063273 | CO | Yes |
Addresses
Primary practice location
401 W Northern Ave
Pueblo, CO 81004-3111
Mailing address
401 W Northern Ave
Pueblo, CO 81004-3111
Phone (719) 553-0400
Other providers in Pueblo, CO
- Michelle S Duran
- Tomas Leonides Duran
- Kathryn M Duren
- Mary Duval
- Loretta Michelle Duverney
- Hailey Duzenack
- Nariyanne Dy
- Charles R Dygert
- Dynamic Physical Therapy LLC
- Karen Eagle
All providers in Pueblo, CO · Family Medicine Physician in Colorado
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 29, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.