Provider Demographics
NPI:1093707739
Name:LEIBOLD, ANN M (MD)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:M
Last Name:LEIBOLD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:M
Other - Last Name:SCHLAGENHAFT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:7447 E BERRY AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-2146
Mailing Address - Country:US
Mailing Address - Phone:303-758-1449
Mailing Address - Fax:303-758-0233
Practice Address - Street 1:7447 E BERRY AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-2146
Practice Address - Country:US
Practice Address - Phone:303-758-1449
Practice Address - Fax:303-758-0233
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO28618207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO14424860Medicaid
CO14424860Medicaid
COG18524Medicare UPIN