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General NPI Number Information
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NPI Number | 1902121536
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Entity Type | Individual
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Provider Name | LAURA A SOUSLIAN M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/07/2010
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Last Update Date | 10/22/2021
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Provider Practice Location Address
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Address Line | 7720 S BROADWAY STE 410
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City | LITTLETON
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State | CO
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Zip | 80122-2624
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Country | US
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Telephone | 303-577-9005
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Fax | 303-577-9006
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Provider Business Mailing Address
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Address Line | 3333 S BANNOCK ST SUITE 350
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City | ENGLEWOOD
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State | CO
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Zip | 80110-2446
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Country | US
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Telephone | 303-957-1310
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Fax | 303-798-1233
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 58685
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 62599
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License Number State | CO
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