Provider Demographics
NPI:1215992474
Name:WAKESHIMA, YUSUKE (MD)
Entity type:Individual
Prefix:DR
First Name:YUSUKE
Middle Name:
Last Name:WAKESHIMA
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 1:2150 W 29TH AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80211-3844
Mailing Address - Country:US
Mailing Address - Phone:303-331-6744
Mailing Address - Fax:
Practice Address - Street 1:2150 W 29TH AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80211-3844
Practice Address - Country:US
Practice Address - Phone:303-331-6744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO38757208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO68925085Medicaid
CO68925085Medicaid
COC811657Medicare PIN