Healthcare Provider Details

I. General information

NPI: 1356326300
Provider Name (Legal Business Name): KENNETH BOOTH KURICA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 08/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5390 N ACADEMY BLVD SUITE 300
COLORADO SPRINGS CO
80918-4062
US

IV. Provider business mailing address

5390 N ACADEMY BLVD SUITE 300
COLORADO SPRINGS CO
80918-4062
US

V. Phone/Fax

Practice location:
  • Phone: 719-596-6110
  • Fax: 719-596-6112
Mailing address:
  • Phone: 719-596-6110
  • Fax: 719-596-6112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number23258
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number23258
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: