Provider Demographics
NPI:1790780989
Name:ANSELMI, EDWIN (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:
Last Name:ANSELMI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7960 S UNIVERSITY BLVD STE 203
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80122-3167
Mailing Address - Country:US
Mailing Address - Phone:720-344-2680
Mailing Address - Fax:720-344-2681
Practice Address - Street 1:7960 S UNIVERSITY BLVD STE 203
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80122-3167
Practice Address - Country:US
Practice Address - Phone:720-344-2680
Practice Address - Fax:720-344-2681
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-15
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO39788207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO90677579Medicaid
CO439618Medicare ID - Type Unspecified
CO90677579Medicaid