MEDICARE: LISA JULIE RENNER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	33586	CO
2	2084P0804X	Child & Adolescent Psychiatry Physician	33586	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740280726
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA JULIE RENNER M.D.

Provider Business Mailing Address
First Line	:	360 S MONROE ST
Second Line	:	SUITE 250
City	:	DENVER
State	:	CO
Zip	:	80209-3705
Country	:	US
Telephone Number	:	303-333-1232
Fax Number	:	303-333-2575

Provider Business Practice Location Address
First Line	:	360 S MONROE ST
Second Line	:	SUITE 250
City	:	DENVER
State	:	CO
Zip	:	80209-3705
Country	:	US
Telephone Number	:	303-333-1232
Fax Number	:	303-333-2575

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2005
Last Update Date	:	03/14/2008

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