Provider Demographics
NPI:1205064961
Name:L.E. HABERSTROH M.D. P.C.
Entity type:Organization
Organization Name:L.E. HABERSTROH M.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:L
Authorized Official - Middle Name:E
Authorized Official - Last Name:HABERSTROH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-604-8431
Mailing Address - Street 1:PO BOX 6332
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-0332
Mailing Address - Country:US
Mailing Address - Phone:847-604-8431
Mailing Address - Fax:847-604-8949
Practice Address - Street 1:1131 HUMBOLDT ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-3123
Practice Address - Country:US
Practice Address - Phone:847-604-8431
Practice Address - Fax:847-604-8949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-01
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO26110207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty