Provider Demographics
NPI:1023102498
Name:CHIMOSKEY, STEFAN J (MD)
Entity type:Individual
Prefix:
First Name:STEFAN
Middle Name:J
Last Name:CHIMOSKEY
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:PO BOX 26666
Mailing Address - Street 2:PHS PROVIDER ENROLLMENT
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87125-6666
Mailing Address - Country:US
Mailing Address - Phone:505-923-5356
Mailing Address - Fax:505-923-5354
Practice Address - Street 1:3601 ARAPAHOE AVE
Practice Address - Street 2:UNIT D180
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-1584
Practice Address - Country:US
Practice Address - Phone:720-845-5858
Practice Address - Fax:505-288-3642
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2001156207Q00000X
NM2001-156207QS1201X
CO0052058207QS1201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS1201XAllopathic & Osteopathic PhysiciansFamily MedicineSleep Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM35424737Medicaid
H59334Medicare UPIN
NM35424737Medicaid