Provider Demographics
NPI:1295728467
Name:ACKERMAN, DONNA L (DO)
Entity type:Individual
Prefix:DR
First Name:DONNA
Middle Name:L
Last Name:ACKERMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6801 S YOSEMITE ST
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-1406
Mailing Address - Country:US
Mailing Address - Phone:303-773-9000
Mailing Address - Fax:
Practice Address - Street 1:3260 E 104TH AVE
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80233-4406
Practice Address - Country:US
Practice Address - Phone:720-929-8300
Practice Address - Fax:720-929-8444
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO32553208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01235539Medicaid
F40167Medicare UPIN
CO01235539Medicaid