Healthcare Provider Details

I. General information

NPI: 1568643708
Provider Name (Legal Business Name): LAURA KAY POMERENKE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2007
Last Update Date: 01/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 S UNION BLVD SUITE 310
COLORADO SPRINGS CO
80910-3113
US

IV. Provider business mailing address

2695 ROCKY MOUNTAIN AVE SUITE 150
LOVELAND CO
80538-8702
US

V. Phone/Fax

Practice location:
  • Phone: 719-477-0211
  • Fax: 719-364-2570
Mailing address:
  • Phone: 970-624-4443
  • Fax: 970-490-4175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number34528
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: