Provider Demographics
NPI:1134459621
Name:DEIBEL, ALEKSANDRA GRZESZCZAK (MD)
Entity Type:Individual
Prefix:
First Name:ALEKSANDRA
Middle Name:GRZESZCZAK
Last Name:DEIBEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ALEKSANDRA
Other - Middle Name:GRZESZCZAK
Other - Last Name:BUHR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3333 S WADSWORTH BLVD UNIT D160
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80227-5131
Mailing Address - Country:US
Mailing Address - Phone:850-778-2795
Mailing Address - Fax:850-807-5096
Practice Address - Street 1:3333 S WADSWORTH BLVD UNIT D160
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80227-5131
Practice Address - Country:US
Practice Address - Phone:850-778-2795
Practice Address - Fax:850-807-5096
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-05
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-37451208D00000X
TN49425207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103I085407Medicare PIN
VAVV8430BMedicare PIN