Healthcare Provider Details

I. General information

NPI: 1255755716
Provider Name (Legal Business Name): KYLE GRIMES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2014
Last Update Date: 07/15/2025
Certification Date: 07/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13123 E 16TH AVE
AURORA CO
80045-7106
US

IV. Provider business mailing address

10876 HEATHERTON ST
HIGHLANDS RANCH CO
80130-6623
US

V. Phone/Fax

Practice location:
  • Phone: 720-777-2940
  • Fax:
Mailing address:
  • Phone: 406-439-0109
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101258686
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberDR.0075031
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: