Provider Demographics
NPI:1962582650
Name:HABERSTROH, LAUREL (MD)
Entity type:Individual
Prefix:
First Name:LAUREL
Middle Name:
Last Name:HABERSTROH
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:PO BOX 6332
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-0332
Mailing Address - Country:US
Mailing Address - Phone:303-808-0694
Mailing Address - Fax:
Practice Address - Street 1:1131 HUMBOLDT ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-3123
Practice Address - Country:US
Practice Address - Phone:303-808-0694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO26110207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
COD24750Medicare UPIN
COC37571Medicare PIN