Provider Demographics
NPI:1568560043
Name:BERENBAUM, WENDY (MD)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:BERENBAUM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 S. CHERRY STREET
Mailing Address - Street 2:SUITE 300
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80246-1230
Mailing Address - Country:US
Mailing Address - Phone:303-388-4631
Mailing Address - Fax:303-320-6961
Practice Address - Street 1:425 S. CHERRY STREET
Practice Address - Street 2:SUITE 300
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80246-1230
Practice Address - Country:US
Practice Address - Phone:303-388-4631
Practice Address - Fax:303-320-6961
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO27517207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01275171Medicaid
COE21782Medicare UPIN
CO325228Medicare ID - Type Unspecified