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General NPI Number Information
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NPI Number | 1205064961
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Entity Type | Organization
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Legal Business Name | L.E. HABERSTROH M.D. P.C.
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Dates
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Enumeration Date | 07/01/2009
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Last Update Date | 07/01/2009
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Provider Practice Location Address
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Address Line | 1131 HUMBOLDT ST
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City | DENVER
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State | CO
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Zip | 80218-3123
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Country | US
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Telephone | 847-604-8431
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Fax | 847-604-8949
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Provider Business Mailing Address
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Address Line | PO BOX 6332
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City | DENVER
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State | CO
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Zip | 80206-0332
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Country | US
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Telephone | 847-604-8431
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Fax | 847-604-8949
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Authorized Official
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Title or Position | PRESIDENT
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Name | L E HABERSTROH
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Credential | M.D.
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Telephone | 847-604-8431
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 26110
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License Number State | CO
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