Provider Demographics
NPI:1295857720
Name:FANASCH, HILAL MAHMOOD (MD)
Entity Type:Individual
Prefix:
First Name:HILAL
Middle Name:MAHMOOD
Last Name:FANASCH
Suffix:
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 1:7750 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80122-2623
Mailing Address - Country:US
Mailing Address - Phone:303-734-2090
Mailing Address - Fax:303-734-2095
Practice Address - Street 1:4400 E FLAMINGO AVE STE 130
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83687-9203
Practice Address - Country:US
Practice Address - Phone:208-205-0350
Practice Address - Fax:208-205-0356
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCDRH.0061344207RH0003X
KS04-49199207RH0003X
TXK1430207RH0003X
IDMC-2502207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX122170708Medicaid
TXTXB142535Medicare PIN
TXF26354Medicare UPIN