Provider Demographics
NPI:1104930528
Name:CHAE, STEVEN (MD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:CHAE
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 1:12510 E ILIFF AVE
Mailing Address - Street 2:STE 210
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-6376
Mailing Address - Country:US
Mailing Address - Phone:303-695-1977
Mailing Address - Fax:303-695-1975
Practice Address - Street 1:12510 E ILIFF AVE
Practice Address - Street 2:STE 210
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-6376
Practice Address - Country:US
Practice Address - Phone:303-695-1977
Practice Address - Fax:303-695-1975
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO40716207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO23577762Medicaid
C486788Medicare ID - Type Unspecified
CO23577762Medicaid