Healthcare Provider Details

I. General information

NPI: 1952961872
Provider Name (Legal Business Name): CORINNE ALICE PANASIUK DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CORINNE HALSTED

II. Dates (important events)

Enumeration Date: 06/13/2019
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7701 SHERIDAN BLVD
WESTMINSTER CO
80003-2605
US

IV. Provider business mailing address

10350 E DAKOTA AVE
DENVER CO
80247-1314
US

V. Phone/Fax

Practice location:
  • Phone: 303-338-4545
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number009770
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDR.0077221
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2019018921
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: