Provider Demographics
NPI:1841795812
Name:SENDELWECK, MYRA ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:MYRA
Middle Name:ANN
Last Name:SENDELWECK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MYRA
Other - Middle Name:
Other - Last Name:KILLEEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10099 RIDGEGATE PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-5532
Mailing Address - Country:US
Mailing Address - Phone:720-875-2880
Mailing Address - Fax:720-875-2877
Practice Address - Street 1:9395 CROWN CREST BLVD
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80138-8573
Practice Address - Country:US
Practice Address - Phone:303-643-0124
Practice Address - Fax:303-269-4070
Is Sole Proprietor?:No
Enumeration Date:2018-03-29
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0066750207R00000X, 208M00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO029291OtherKAISER COMMERCIAL NUMBER
CO9000164246Medicaid