Provider Demographics
NPI:1750358081
Name:ANSTADT, DAVID LARUE (MD,)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:LARUE
Last Name:ANSTADT
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 1:1526 COLE BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80401-3410
Mailing Address - Country:US
Mailing Address - Phone:303-379-9371
Mailing Address - Fax:303-423-7004
Practice Address - Street 1:30575 BAINBRIDGE RD STE 300
Practice Address - Street 2:
Practice Address - City:SOLON
Practice Address - State:OH
Practice Address - Zip Code:44139-2275
Practice Address - Country:US
Practice Address - Phone:440-368-6868
Practice Address - Fax:440-368-6866
Is Sole Proprietor?:No
Enumeration Date:2006-03-06
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.040465207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0538430Medicaid
OHA15445Medicare UPIN
OH0538430Medicaid