Provider Demographics
NPI:1235119553
Name:BLEISTEIN, ABBY LISE (MD)
Entity type:Individual
Prefix:
First Name:ABBY
Middle Name:LISE
Last Name:BLEISTEIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 ELDORADO BLVD STE 6250
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80021-3421
Mailing Address - Country:US
Mailing Address - Phone:303-272-0768
Mailing Address - Fax:303-318-2488
Practice Address - Street 1:2600 CAMPUS DR
Practice Address - Street 2:SUITE A
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-3357
Practice Address - Country:US
Practice Address - Phone:303-673-1900
Practice Address - Fax:303-673-1915
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO39420207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
COP00773004OtherMEDICARE RAILROAD
CO43753311Medicaid
H44468Medicare UPIN
CO43753311Medicaid