Provider Demographics
NPI:1477755718
Name:THORNDIKE, LORI LYNN HOLST (DO)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:LYNN HOLST
Last Name:THORNDIKE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:LYNN
Other - Last Name:HOLST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:500 ELDORADO BLVD # 6250
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80021-3408
Mailing Address - Country:US
Mailing Address - Phone:303-272-0751
Mailing Address - Fax:303-318-2488
Practice Address - Street 1:3814 E 120TH AVE
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80233-1608
Practice Address - Country:US
Practice Address - Phone:303-452-2046
Practice Address - Fax:303-280-0942
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO44567207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO47627719Medicaid
COCOA100006Medicare PIN