Healthcare Provider Details

I. General information

NPI: 1942835061
Provider Name (Legal Business Name): ANTON MAKHIBORODA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2020
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3520 W OXFORD AVE # 80236
DENVER CO
80236-3108
US

IV. Provider business mailing address

3520 W OXFORD AVE
DENVER CO
80236-3108
US

V. Phone/Fax

Practice location:
  • Phone: 303-866-7066
  • Fax:
Mailing address:
  • Phone: 303-866-7066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberDR.0074870
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: