Healthcare Provider Details

I. General information

NPI: 1043582992
Provider Name (Legal Business Name): HM KILZER MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2012
Last Update Date: 02/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1338 PHAY AVE
CANON CITY CO
81212-2302
US

IV. Provider business mailing address

1001 E HARMONY RD UNIT A UNIT 509
FORT COLLINS CO
80525-8888
US

V. Phone/Fax

Practice location:
  • Phone: 719-285-2000
  • Fax:
Mailing address:
  • Phone: 702-453-3799
  • Fax: 702-453-5741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number26126
License Number StateCO

VIII. Authorized Official

Name: LORI LABRECQUE
Title or Position: ACCTS MGR
Credential:
Phone: 702-453-3799