Provider Demographics
NPI:1134227291
Name:ELANE SHIRAR MD INC
Entity type:Organization
Organization Name:ELANE SHIRAR MD INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:L
Authorized Official - Middle Name:ELANE
Authorized Official - Last Name:SHIRAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-430-0240
Mailing Address - Street 1:11166 HURON ST STE 27
Mailing Address - Street 2:
Mailing Address - City:NORTHGLENN
Mailing Address - State:CO
Mailing Address - Zip Code:80234-3339
Mailing Address - Country:US
Mailing Address - Phone:303-430-0240
Mailing Address - Fax:303-430-5883
Practice Address - Street 1:11166 HURON ST STE 27
Practice Address - Street 2:
Practice Address - City:NORTHGLENN
Practice Address - State:CO
Practice Address - Zip Code:80234-3339
Practice Address - Country:US
Practice Address - Phone:303-430-0240
Practice Address - Fax:303-430-5883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO33226207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC373808Medicare PIN