Healthcare Provider Details

I. General information

NPI: 1225009798
Provider Name (Legal Business Name): KEVIN CORRIGAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 S CASCADE AVE 140
COLORADO SPRINGS CO
80903-1624
US

IV. Provider business mailing address

5955 LEHMAN DR
COLORADO SPRINGS CO
80918-3420
US

V. Phone/Fax

Practice location:
  • Phone: 719-538-2936
  • Fax: 719-538-2961
Mailing address:
  • Phone: 719-538-5727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number30988
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: