Provider Demographics
NPI:1770564437
Name:ANISIMOVA, ELENA (MD)
Entity type:Individual
Prefix:DR
First Name:ELENA
Middle Name:
Last Name:ANISIMOVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:YELENA
Other - Middle Name:
Other - Last Name:ANISIMOVA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1260 S PARKER RD
Mailing Address - Street 2:STE 201
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-8064
Mailing Address - Country:US
Mailing Address - Phone:303-802-5444
Mailing Address - Fax:303-848-4805
Practice Address - Street 1:1260 S PARKER RD STE 201
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80231
Practice Address - Country:US
Practice Address - Phone:
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-09
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO41995207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO59807555Medicaid
CO70533067Medicaid
COI02323Medicare UPIN
CO59807555Medicaid
COCO306566Medicare PIN
COC523068Medicare PIN