Healthcare Provider Details

I. General information

NPI: 1104315019
Provider Name (Legal Business Name): ANDREW XU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2018
Last Update Date: 06/11/2021
Certification Date: 06/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11083 COLORADO BLVD
FIRESTONE CO
80504-5873
US

IV. Provider business mailing address

11083 COLORADO BLVD
FIRESTONE CO
80504-5873
US

V. Phone/Fax

Practice location:
  • Phone: 303-833-8880
  • Fax: 303-682-8007
Mailing address:
  • Phone: 303-833-8880
  • Fax: 303-682-8007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberTL.0007372
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberTL.0007372
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDR.0064282
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: