Healthcare Provider Details

I. General information

NPI: 1669520979
Provider Name (Legal Business Name): SARA KATE ANDERSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 05/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9480 BRIAR VILLAGE PT STE 200
COLORADO SPRINGS CO
80920-7923
US

IV. Provider business mailing address

99-708 HOLOAI ST
AIEA HI
96701-3580
US

V. Phone/Fax

Practice location:
  • Phone: 719-623-2101
  • Fax: 719-278-3627
Mailing address:
  • Phone: 808-371-6646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD12473
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberDR.0051007
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: