Provider Demographics
NPI:1073784096
Name:ELENA ANISIMOVA, MD, PC
Entity Type:Organization
Organization Name:ELENA ANISIMOVA, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANISIMOVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-802-5444
Mailing Address - Street 1:1260 S PARKER RD # 201
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-8064
Mailing Address - Country:US
Mailing Address - Phone:303-802-5444
Mailing Address - Fax:303-728-9872
Practice Address - Street 1:1260 S PARKER RD # 201
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80231
Practice Address - Country:US
Practice Address - Phone:303-802-5444
Practice Address - Fax:303-728-9872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-18
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO41995207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COI02323Medicare UPIN