Provider Demographics
NPI:1952585879
Name:BANNIGAN, WENDY J (DO)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:J
Last Name:BANNIGAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:J
Other - Last Name:MCBRIDE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:2349 N LAFAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80205-5341
Mailing Address - Country:US
Mailing Address - Phone:303-525-6314
Mailing Address - Fax:303-306-7753
Practice Address - Street 1:10101 RIDGEGATE CENTER
Practice Address - Street 2:
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-9810
Practice Address - Country:US
Practice Address - Phone:720-225-1900
Practice Address - Fax:303-306-7753
Is Sole Proprietor?:No
Enumeration Date:2007-12-27
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0046454207PP0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PP0204XAllopathic & Osteopathic PhysiciansEmergency MedicinePediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO90006739Medicaid
CO340479YL2GMedicare PIN