Basic Information
| Provider Information | |||||||||
| NPI: | 1245240902 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRENMAN | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | ADLEY | ||||||||
| NamePrefix: | |||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12645 E EUCLID DR | ||||||||
| Address2: | |||||||||
| City: | CENTENNIAL | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801116437 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034931910 | ||||||||
| FaxNumber: | 3034931915 | ||||||||
| Practice Location | |||||||||
| Address1: | 12645 E EUCLID DR | ||||||||
| Address2: | |||||||||
| City: | CENTENNIAL | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801116437 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034931910 | ||||||||
| FaxNumber: | 3034931915 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/08/2006 | ||||||||
| LastUpdateDate: | 04/09/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | 24444 | CO | Y | Allopathic & Osteopathic Physicians | Dermatology |
ID Information
| ID | Type | State | Issuer | Description | 01244441 | 05 | CO | MEDICAID |