Provider Demographics
NPI:1720118573
Name:MIRSHAB, CYRUS A (MD)
Entity Type:Individual
Prefix:DR
First Name:CYRUS
Middle Name:A
Last Name:MIRSHAB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:238 CLEMENTINA ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-9469
Mailing Address - Country:US
Mailing Address - Phone:303-521-6278
Mailing Address - Fax:
Practice Address - Street 1:238 CLEMENTINA ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-9469
Practice Address - Country:US
Practice Address - Phone:303-521-6278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO39165207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
016356OtherKAISER-COMMERCIAL NUMBER
CO54380243Medicaid
COI10052Medicare UPIN
CO54380243Medicaid