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General NPI Number Information
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NPI Number | 1750358081
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Entity Type | Individual
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Provider Name | DAVID LARUE ANSTADT M.D,
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Gender | Male
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Dates
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Enumeration Date | 03/06/2006
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Last Update Date | 07/22/2019
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Provider Practice Location Address
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Address Line | 30575 BAINBRIDGE RD STE 300
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City | SOLON
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State | OH
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Zip | 44139-2275
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Country | US
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Telephone | 440-368-6868
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Fax | 440-368-6866
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Provider Business Mailing Address
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Address Line | 1526 COLE BLVD STE 300
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City | LAKEWOOD
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State | CO
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Zip | 80401-3410
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Country | US
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Telephone | 303-379-9371
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Fax | 303-423-7004
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 35.040465
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License Number State | OH
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