Healthcare Provider Details

I. General information

NPI: 1437131547
Provider Name (Legal Business Name): KARL MARTIN LARSEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2005
Last Update Date: 11/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2446 RESEARCH PKWY SUITE 200
COLORADO SPRINGS CO
80920-1087
US

IV. Provider business mailing address

2446 RESEARCH PKWY SUITE 200
COLORADO SPRINGS CO
80920-1087
US

V. Phone/Fax

Practice location:
  • Phone: 719-623-1050
  • Fax: 719-623-1052
Mailing address:
  • Phone: 719-623-1050
  • Fax: 719-623-1052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number41401
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number41401
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number43404
License Number StateCO
# 4
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number43404
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: