Healthcare Provider Details

I. General information

NPI: 1588124408
Provider Name (Legal Business Name): LEAH KELLOGG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2019
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7550 W YALE AVE STE B100
DENVER CO
80227-3460
US

IV. Provider business mailing address

PO BOX 35380
LAS VEGAS NV
89133-5380
US

V. Phone/Fax

Practice location:
  • Phone: 303-935-4689
  • Fax: 303-935-3829
Mailing address:
  • Phone: 702-579-3253
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDR.0065944
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: