MEDICARE: THOMAS P KITTELSEN MD

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	2084P0800X	Psychiatry Physician	8734	NV
2	2084P0800X	Psychiatry Physician	CDRH.0047433	CO

General Provider Information

NPI Number	:	1184750408
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS P KITTELSEN MD

Provider Business Mailing Address
First Line	:	4791 AMAROSA HTS APT 204
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-7929
Country	:	US
Telephone Number	:	719-306-4543
Fax Number	:	833-953-0009

Provider Business Practice Location Address
First Line	:	7680 GODDARD ST STE 120
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-8233
Country	:	US
Telephone Number	:	719-306-4543
Fax Number	:	833-953-0009

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

Provider Enumeration Date	:	02/23/2007
Last Update Date	:	10/02/2019

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Directions to “ THOMAS P KITTELSEN MD” Practice Location

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