Provider Demographics
NPI:1124006119
Name:LANIG, INDIRA S (MD)
Entity Type:Individual
Prefix:
First Name:INDIRA
Middle Name:S
Last Name:LANIG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6834 S UNIVERSITY BLVD
Mailing Address - Street 2:#122
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80122-1515
Mailing Address - Country:US
Mailing Address - Phone:303-761-1215
Mailing Address - Fax:303-762-1701
Practice Address - Street 1:4401 UNION ST
Practice Address - Street 2:NORTHERN COLORADO REHABILITATION HOSPITAL
Practice Address - City:JOHNSTOWN
Practice Address - State:CO
Practice Address - Zip Code:80534-2800
Practice Address - Country:US
Practice Address - Phone:303-761-1215
Practice Address - Fax:303-762-1701
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG8233208100000X
CODR00293142081P0004X, 208100000X
WAMD60610353208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081P0004XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSpinal Cord Injury Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE100261155-00Medicaid
WY1124006119Medicaid
CO01293141Medicaid
NE100261155-00Medicaid
CO01293141Medicaid