Provider Demographics
NPI:1548402449
Name:SEEFELDT, BRIEANNA MIKEL CROSS (DO)
Entity Type:Individual
Prefix:
First Name:BRIEANNA
Middle Name:MIKEL CROSS
Last Name:SEEFELDT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:16 LAKESIDE LN
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80212-7413
Mailing Address - Country:US
Mailing Address - Phone:303-422-2236
Mailing Address - Fax:303-360-0266
Practice Address - Street 1:8015 W ALAMEDA AVE
Practice Address - Street 2:STE 210
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226-3041
Practice Address - Country:US
Practice Address - Phone:303-268-1577
Practice Address - Fax:303-238-5832
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-24
Last Update Date:2016-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO50338207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO64370348Medicaid
COP01221188Medicare PIN
COCOA107662Medicare PIN