Provider Demographics
NPI:1356875603
Name:IDE, ADRIENNE (DO)
Entity type:Individual
Prefix:DR
First Name:ADRIENNE
Middle Name:
Last Name:IDE
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 1:16623 CONCOLOR PL
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-3999
Mailing Address - Country:US
Mailing Address - Phone:218-348-1700
Mailing Address - Fax:303-309-3733
Practice Address - Street 1:1411 S POTOMAC ST STE 300
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-4539
Practice Address - Country:US
Practice Address - Phone:303-531-4910
Practice Address - Fax:303-309-3733
Is Sole Proprietor?:No
Enumeration Date:2017-04-13
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0061348207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine