Basic Information
Provider Information
NPI: 1588059042
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BREITBACH
FirstName: ELIZABETH
MiddleName: KAYE
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1700 N. WHEELING STREET
Address2:  
City: AURORA
State: CO
PostalCode: 80045
CountryCode: US
TelephoneNumber: 3033998020
FaxNumber:  
Practice Location
Address1: 1700 N. WHEELING STREET
Address2:  
City: AURORA
State: CO
PostalCode: 80045
CountryCode: US
TelephoneNumber: 3033998020
FaxNumber:  
Other Information
ProviderEnumerationDate: 04/01/2015
LastUpdateDate: 08/02/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000XDR.0060544COY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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