Provider Demographics
NPI:1871579011
Name:BRENNEMAN, JANICE K (MD)
Entity type:Individual
Prefix:DR
First Name:JANICE
Middle Name:K
Last Name:BRENNEMAN
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 1:10800 E GEDDES AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80112-3895
Mailing Address - Country:US
Mailing Address - Phone:303-761-9190
Mailing Address - Fax:720-874-4462
Practice Address - Street 1:501 E HAMPDEN AVE
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-2702
Practice Address - Country:US
Practice Address - Phone:303-761-9190
Practice Address - Fax:720-874-4462
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE250972085R0202X
KS04-183492085R0202X
HIMD175402085R0202X
CO224002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1871579011Medicaid
MT1871579011Medicaid
MN1871579011Medicaid
NM84738022Medicaid
CA1871579011Medicaid
NE84-059792913Medicaid
AKMD711COMedicaid
NE10025709000Medicaid
ID807445600Medicaid
NY02300190Medicaid
WY1871579011Medicaid
CO01224005Medicaid
TX053215201Medicaid
MI104686042Medicaid
KS200418380AMedicaid
IA1871579011Medicaid
AZ651886Medicaid
AZ651886Medicaid
COC22224Medicare PIN
CO391142ZLJ3Medicare PIN
CO300089925Medicare PIN
WY1871579011Medicaid
ID807445600Medicaid
NE10025709000Medicaid
TX053215201Medicaid
NENA2517056Medicare PIN
NEP00796290Medicare PIN
COCW4108Medicare PIN
AZ651886Medicaid
IA1871579011Medicaid
NE84-059792913Medicaid