Provider Demographics
NPI:1851425326
Name:LAURICE ISKANDER MD PC
Entity Type:Organization
Organization Name:LAURICE ISKANDER MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAURICE
Authorized Official - Middle Name:
Authorized Official - Last Name:ISKANDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-340-1959
Mailing Address - Street 1:3464 S WILLOW ST
Mailing Address - Street 2:SUITE 647
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-4531
Mailing Address - Country:US
Mailing Address - Phone:303-755-2900
Mailing Address - Fax:
Practice Address - Street 1:730 POTOMAC ST
Practice Address - Street 2:SUITE 316
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80011-6703
Practice Address - Country:US
Practice Address - Phone:303-340-1959
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04020491Medicaid