Provider Demographics
NPI:1366412876
Name:LEOPOLD, LORI A (DO)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:A
Last Name:LEOPOLD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6179 S BALSAM WAY
Mailing Address - Street 2:SUITE #110
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80123-3091
Mailing Address - Country:US
Mailing Address - Phone:303-948-1570
Mailing Address - Fax:
Practice Address - Street 1:6179 S BALSAM WAY
Practice Address - Street 2:SUITE #110
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80123-3091
Practice Address - Country:US
Practice Address - Phone:303-948-1570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-25
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS2390207Q00000X
AZ007486207Q00000X
MTMED-PHYS-LIC-66302207Q00000X
NMA-2152-18207Q00000X
SD10823207Q00000X
IL036145321207Q00000X
WAOP60820743207Q00000X
WY11407C207Q00000X
IDOC-0012207Q00000X
WI14-321207Q00000X
CA20A16244207Q00000X
NVDO2337207Q00000X
MN63434207Q00000X
ORDO191682207Q00000X
COCDRH.0041943207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H63098Medicare UPIN