Provider Demographics
NPI:1396732079
Name:AUDET, ISABELLE MARIE-MARTHE (MD)
Entity type:Individual
Prefix:DR
First Name:ISABELLE
Middle Name:MARIE-MARTHE
Last Name:AUDET
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 1:9351 GRANT ST
Mailing Address - Street 2:400
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80229-4358
Mailing Address - Country:US
Mailing Address - Phone:303-452-0059
Mailing Address - Fax:
Practice Address - Street 1:9351 GRANT ST
Practice Address - Street 2:400
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80229-4358
Practice Address - Country:US
Practice Address - Phone:303-452-0059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-29
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301073775208600000X
CO49355208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4437010Medicaid
MI4437010Medicaid
G51464Medicare UPIN