Provider Demographics
NPI:1750482303
Name:GROVER, ISABELLE EVENCHICK (MD)
Entity Type:Individual
Prefix:DR
First Name:ISABELLE
Middle Name:EVENCHICK
Last Name:GROVER
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 1:2275 GARLAND ST
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80215-1629
Mailing Address - Country:US
Mailing Address - Phone:303-234-9163
Mailing Address - Fax:
Practice Address - Street 1:2275 GARLAND ST
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80215-1629
Practice Address - Country:US
Practice Address - Phone:720-771-4637
Practice Address - Fax:303-234-9163
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO20598207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01205988Medicaid
D28255Medicare UPIN