Provider Demographics
NPI:1811080401
Name:BISSELL, MARY ELIZABETH (MD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ELIZABETH
Last Name:BISSELL
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:90 HEALTHPARK DRIVE
Mailing Address - Street 2:SUITE 190
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027
Mailing Address - Country:US
Mailing Address - Phone:303-673-0224
Mailing Address - Fax:303-673-0259
Practice Address - Street 1:90 HEALTHPARK DRIVE
Practice Address - Street 2:SUITE 190
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027
Practice Address - Country:US
Practice Address - Phone:303-673-0224
Practice Address - Fax:303-673-0259
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2016-06-09
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Provider Licenses
StateLicense IDTaxonomies
CODR.0028891207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
COE84036Medicare UPIN