Provider Demographics
NPI:1922054790
Name:IMHOF, ANN MAC DONALD (MD)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:MAC DONALD
Last Name:IMHOF
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 1:2200 E 104TH AVE STE 115
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80233-4402
Mailing Address - Country:US
Mailing Address - Phone:303-466-1341
Mailing Address - Fax:
Practice Address - Street 1:2200 EAST 104 AVENUE
Practice Address - Street 2:SUITE 115
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80233
Practice Address - Country:US
Practice Address - Phone:303-452-2766
Practice Address - Fax:303-252-8694
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO40988207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO56121873Medicaid