GREENSPAN, STACY L (DO)

Provider Demographics

• NPI: 1336124825
• Name: GREENSPAN, STACY L (DO)
• Entity Type: Individual
• First Name: STACY
• Middle Name: L
• Last Name: GREENSPAN
• Gender: F
• Credentials: DO
• Mailing Address - Street 1: 11995 SINGLETREE LN
• Mailing Address - Street 2: SUITE 500
• Mailing Address - City: EDEN PRAIRIE
• Mailing Address - State: MN
• Mailing Address - Zip Code: 55344-5347
• Mailing Address - Country: US
• Mailing Address - Phone: 952-595-1301
• Mailing Address - Fax: 612-294-4903
• Practice Address - Street 1: 2912 CATHEDRAL PARK VW
• Practice Address - City: COLORADO SPRINGS
• Practice Address - State: CO
• Practice Address - Zip Code: 80904-4722
• Practice Address - Country: US
• Practice Address - Phone: 952-595-1100
• Practice Address - Fax: 612-294-4903
• Is Sole Proprietor?: No
• Enumeration Date: 2005-12-07
• Last Update Date: 2015-06-24

Provider Licenses

State	License ID	Taxonomies
CO	37796	2085R0202X
NE	1164	2085R0202X
KS	05-37082	2085R0202X
HI	1592	2085R0202X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization
Yes	2085R0202X	Allopathic & Osteopathic Physicians	Radiology	Diagnostic Radiology

Provider Identifiers

State	Identifier ID	ID Type	Issuer
NE	84089712600	Medicaid
NE	840859792913	Medicaid
UT	1336124825	Medicaid
NE	NA2517031	Medicare PIN
NE	NA1215086	Medicare PIN
CO	464918	Medicare PIN
NE	10026277300	Medicaid
CO	P01296580	Medicare PIN
CO	C484128	Medicare PIN
CO	271278YQ33	Medicare PIN
CO	G59043	Medicare UPIN
NE	10026277600	Medicaid
NE	10026277700	Medicaid
CO	57029251	Medicaid
KS	201092110A	Medicaid
NE	10026277500	Medicaid
NE	10026277800	Medicaid
MT	1336124825	Medicaid
CO	P01317129	Medicare PIN
AZ	808230	Medicaid
OK	200067690A	Medicaid
KS	KA3249026	Medicare PIN
WY	1336124825	Medicaid
NE	10025709000	Medicaid
NE	10026277400	Medicaid
NE	NA1214086	Medicare PIN
CO	271278YQPG	Medicare PIN
KS	111257074	Medicare PIN
CO	271278YQN9	Medicare PIN