Healthcare Provider Details

I. General information

NPI: 1437366473
Provider Name (Legal Business Name): ROTEM LASZLO ABRAHAM ELGAVISH MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 10/08/2024
Certification Date: 10/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10103 RIDGEGATE PKWY STE 125
LONE TREE CO
80124-5525
US

IV. Provider business mailing address

11509 E DORADO AVE
ENGLEWOOD CO
80111-4143
US

V. Phone/Fax

Practice location:
  • Phone: 303-790-8899
  • Fax: 303-790-2810
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084E0001X
TaxonomyEpilepsy Physician
License NumberCDRH.0054026
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number2024-02480
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number26149
License Number StateAL
# 4
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberDR.0054026
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: