Provider Demographics
NPI:1538374160
Name:EDWARDS, ELIJAH MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:ELIJAH
Middle Name:MICHAEL
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10350 E DAKOTA AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80247-1314
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1375 E 19TH AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218
Practice Address - Country:US
Practice Address - Phone:303-338-4545
Practice Address - Fax:303-344-7715
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN52770207P00000X
CODR.0047831207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO020492OtherKAISER COMMERCIAL NUMBER
CO81655851Medicaid