Healthcare Provider Details

I. General information

NPI: 1083695316
Provider Name (Legal Business Name): BRUCE L. KAUTZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2005
Last Update Date: 05/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2685 DUBLIN BLVD
COLORADO SPRINGS CO
80918-1358
US

IV. Provider business mailing address

2685 DUBLIN BLVD
COLORADO SPRINGS CO
80918-1358
US

V. Phone/Fax

Practice location:
  • Phone: 719-592-9890
  • Fax: 719-264-6808
Mailing address:
  • Phone: 719-592-9890
  • Fax: 719-264-7808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number30304
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: