BOLOURI, MARJAN SEDIGHA (MD)

Provider Demographics

• NPI: 1790930535
• Name: BOLOURI, MARJAN SEDIGHA (MD)
• Entity Type: Individual
• First Name: MARJAN
• Middle Name: SEDIGHA
• Last Name: BOLOURI
• Gender: F
• Credentials: MD
• Mailing Address - Street 1: 10800 E GEDDES AVE STE 300
• Mailing Address - City: ENGLEWOOD
• Mailing Address - State: CO
• Mailing Address - Zip Code: 80112-3895
• Mailing Address - Country: US
• Mailing Address - Phone: 303-761-9190
• Mailing Address - Fax: 720-874-4462
• Practice Address - Street 1: 501 E HAMPDEN AVE
• Practice Address - City: ENGLEWOOD
• Practice Address - State: CO
• Practice Address - Zip Code: 80113-2702
• Practice Address - Country: US
• Practice Address - Phone: 303-761-9190
• Practice Address - Fax: 720-874-4462
• Is Sole Proprietor?: No
• Enumeration Date: 2008-11-20
• Last Update Date: 2022-12-07

Provider Licenses

State	License ID	Taxonomies
NE	27754	2085R0202X
KS	04-37113	2085R0202X
HI	17588	2085R0202X, 2085R0202X
CO	53503	2085R0202X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization
Yes	2085R0202X	Allopathic & Osteopathic Physicians	Radiology	Diagnostic Radiology

Provider Identifiers

State	Identifier ID	ID Type	Issuer
NE	10026277500	Medicaid
NE	1002627770	Medicaid
WY	1790930535	Medicaid
KS	201098850A	Medicaid
NE	10025709000	Medicaid
OK	200545800A	Medicaid
NE	10026277600	Medicaid
NE	10026277800	Medicaid
NM	92403328	Medicaid
IA	1790930535	Medicaid
HI	0000343871	Other	HMSA ALL PRODUCTS
NE	10026277300	Medicaid
NE	10026277400	Medicaid
MT	1790930535	Medicaid
CO	47184841	Medicaid
UT	1790930535	Medicaid
AZ	935836	Medicaid
KS	111257079	Medicare PIN
NE	NA1215091	Medicare PIN
CO	351986YQ33	Medicare PIN
NE	10026277500	Medicaid
NE	10026277400	Medicaid
OK	200545800A	Medicaid
CO	P01378817	Medicare PIN
CO	351986YQN9	Medicare PIN
NE	10026277600	Medicaid
KS	KA3249066	Medicare PIN
UT	1790930535	Medicaid
KS	201098850A	Medicaid
MT	1790930535	Medicaid
NE	10025709000	Medicaid
CO	351986YQPG	Medicare PIN
HI	H105399	Medicare PIN