Provider Demographics
NPI:1740280726
Name:RENNER, LISA JULIE (MD)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:JULIE
Last Name:RENNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 S MONROE ST
Mailing Address - Street 2:SUITE 250
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80209-3705
Mailing Address - Country:US
Mailing Address - Phone:303-333-1232
Mailing Address - Fax:303-333-2575
Practice Address - Street 1:360 S MONROE ST
Practice Address - Street 2:SUITE 250
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80209-3705
Practice Address - Country:US
Practice Address - Phone:303-333-1232
Practice Address - Fax:303-333-2575
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-29
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO335862084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01335868Medicaid
F55395Medicare UPIN
45679Medicare ID - Type Unspecified