Basic Information
| Provider Information | |||||||||
| NPI: | 1427158047 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KANDEL | ||||||||
| FirstName: | ELISABETH | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1022 DEPOT HILL RD | ||||||||
| Address2: | |||||||||
| City: | BROOMFIELD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800201068 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034652323 | ||||||||
| FaxNumber: | 3034651260 | ||||||||
| Practice Location | |||||||||
| Address1: | 1022 DEPOT HILL RD | ||||||||
| Address2: | |||||||||
| City: | BROOMFIELD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800201068 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034652323 | ||||||||
| FaxNumber: | 3034651260 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/24/2006 | ||||||||
| LastUpdateDate: | 03/23/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 16469 | CO | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 01164698 | 05 | CO | MEDICAID |