Provider Demographics
NPI:1679565758
Name:BYCK, DANN CONRAD III (MD)
Entity type:Individual
Prefix:
First Name:DANN
Middle Name:CONRAD
Last Name:BYCK
Suffix:III
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 1:4105 BRIARGATE PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-3487
Mailing Address - Country:US
Mailing Address - Phone:719-402-0200
Mailing Address - Fax:719-352-0121
Practice Address - Street 1:4105 BRIARGATE PKWY STE 300
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-3487
Practice Address - Country:US
Practice Address - Phone:719-420-0200
Practice Address - Fax:719-352-0121
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT51866291205207X00000X
COCDR.0002201207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
4360680001OtherCIGNA DMERC
870580455OtherAETNA
870680455OtherAM POSTAL WORKERS UNION
870680455OtherCBSA CORPORATE
870680455OtherCCN
UTD4621Medicaid
51866291200001OtherBCBS
870680455OtherBENEFIT PLAN ADMIN
51866291200001OtherBCBS OF OTHER STATE
870680455BYCOtherED IHC CARE PLUS
OM0000058953OtherALTUS
51866291200001OtherBC OF WYO
659750OtherDESERT MUTUAL
870680455OtherCIGNA
870680455OtherEBMS EMPLOYEE BENEFIT
870680455OtherBENEFIT PLANNERS
870680455OtherI159 ACORDIA NATIONAL
870680455OtherBENEFIT PLAN ADMIN
870680455BYCOtherED IHC CARE PLUS
G96202Medicare UPIN