Provider Demographics
NPI:1063448652
Name:IANCU, ELVIRA MARIA (MD)
Entity type:Individual
Prefix:DR
First Name:ELVIRA
Middle Name:MARIA
Last Name:IANCU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ELVIRA
Other - Middle Name:MARIA
Other - Last Name:BRAMCUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10350 E DAKOTA AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80247-1314
Mailing Address - Country:US
Mailing Address - Phone:303-338-4545
Mailing Address - Fax:
Practice Address - Street 1:2950 E HARMONY RD
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80528-3419
Practice Address - Country:US
Practice Address - Phone:303-338-4545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036101367207Q00000X
CO0054705207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO39024776Medicaid
IL036101367Medicaid
IL553180OtherMEDICARE GROUP #
CO025776OtherKAISER COMMERCIAL NUMBER
CO39024776Medicaid
CO025776OtherKAISER COMMERCIAL NUMBER
IL553180OtherMEDICARE GROUP #
ILH17001Medicare UPIN
IL036101367Medicaid
IL834340Medicare ID - Type UnspecifiedMEDICARE GROUP #