Provider Demographics
NPI:1902077332
Name:HSU, ELIAS I-HSIN (MD)
Entity Type:Individual
Prefix:
First Name:ELIAS
Middle Name:I-HSIN
Last Name:HSU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2777 MILE HIGH STADIUM CIR
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80211-5222
Mailing Address - Country:US
Mailing Address - Phone:303-825-8822
Mailing Address - Fax:
Practice Address - Street 1:2777 MILE HIGH STADIUM CIR
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80211-5222
Practice Address - Country:US
Practice Address - Phone:303-825-8822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-13
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM9361208800000X
TXBP30019030208800000X
CO47409208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO74153021Medicaid
TX8K9383Medicare PIN
CO74153021Medicaid
TX8K9384Medicare PIN
TX8K9370Medicare PIN