Provider Demographics
NPI:1740386861
Name:ELLIAS, ANDREW R (DO)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:R
Last Name:ELLIAS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:675 SOUTHPOINTE CT
Mailing Address - Street 2:STE 101
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-3887
Mailing Address - Country:US
Mailing Address - Phone:719-540-5700
Mailing Address - Fax:719-540-5702
Practice Address - Street 1:675 SOUTHPOINTE CT
Practice Address - Street 2:STE 101
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-3887
Practice Address - Country:US
Practice Address - Phone:719-540-5700
Practice Address - Fax:719-540-5702
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO28329207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO75309486701OtherPACIFICARE
E53734OtherFEDERAL BLUE CROSS
COEL8243OtherBLUE SHIELD
CO753094867001OtherROCKY MTN HMO
COC535568Medicare PIN
CO75309486701OtherPACIFICARE