Provider Demographics
NPI:1710334818
Name:YERELIAN, ELISE SIMONE (MD)
Entity Type:Individual
Prefix:MISS
First Name:ELISE
Middle Name:SIMONE
Last Name:YERELIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 801106
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64180-1106
Mailing Address - Country:US
Mailing Address - Phone:800-953-0104
Mailing Address - Fax:303-765-6670
Practice Address - Street 1:2490 W 26TH AVE STE 120A
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80211-5317
Practice Address - Country:US
Practice Address - Phone:303-925-4580
Practice Address - Fax:303-925-4581
Is Sole Proprietor?:No
Enumeration Date:2016-05-18
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CODR.0061182207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000137370Medicaid