Provider Demographics
NPI:1376034793
Name:RASEKH, LILI
Entity type:Individual
Prefix:
First Name:LILI
Middle Name:
Last Name:RASEKH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6343 E GIRARD PL UNIT 235
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-7441
Mailing Address - Country:US
Mailing Address - Phone:720-235-7474
Mailing Address - Fax:
Practice Address - Street 1:6343 E GIRARD PL UNIT 235
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-7441
Practice Address - Country:US
Practice Address - Phone:720-235-7474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-21
Last Update Date:2018-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR0060389208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice