MEDICARE: DR. KEVIN WILLIAM O'DONNELL DO

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	207Q00000X	Family Medicine Physician	DR.0067561	CO
2	207X00000X	Orthopaedic Surgery Physician	DR.0067561	CO
3	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	DR.0067561	CO

General Provider Information

NPI Number	:	1114911492
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEVIN WILLIAM O'DONNELL DO

Provider Business Mailing Address
First Line	:	5161 E ARAPAHOE RD STE 250
Second Line	:
City	:	CENTENNIAL
State	:	CO
Zip	:	80122-4810
Country	:	US
Telephone Number	:	720-463-0567
Fax Number	:

Provider Business Practice Location Address
First Line	:	5161 E ARAPAHOE RD STE 250
Second Line	:
City	:	CENTENNIAL
State	:	CO
Zip	:	80122-4810
Country	:	US
Telephone Number	:	720-463-0567
Fax Number	:

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

Provider Enumeration Date	:	09/01/2005
Last Update Date	:	09/29/2024

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