Provider Demographics
NPI:1366696783
Name:LISA AHRENDT, MD PC
Entity type:Organization
Organization Name:LISA AHRENDT, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:AHRENDT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-788-8675
Mailing Address - Street 1:799 E HAMPDEN AVE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80113-2700
Mailing Address - Country:US
Mailing Address - Phone:303-788-8675
Mailing Address - Fax:
Practice Address - Street 1:799 E HAMPDEN AVE
Practice Address - Street 2:SUITE 500
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-2700
Practice Address - Country:US
Practice Address - Phone:303-788-8675
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-12
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR42824174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO11335386Medicaid
COCOB4339Medicare PIN