Healthcare Provider Details

I. General information

NPI: 1346808672
Provider Name (Legal Business Name): ANJU KANNAPPAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2019
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10375 PARK MEADOWS DR STE 115
LONE TREE CO
80124-6736
US

IV. Provider business mailing address

1805 SHEA CENTER DR STE 450
HIGHLANDS RANCH CO
80129-2255
US

V. Phone/Fax

Practice location:
  • Phone: 303-803-1005
  • Fax: 303-798-3248
Mailing address:
  • Phone: 303-357-2559
  • Fax: 303-798-3248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0068234
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: