Healthcare Provider Details

I. General information

NPI: 1992900575
Provider Name (Legal Business Name): MARY KRISTEN DEMORUELLE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY K DEMORUELLE MD

II. Dates (important events)

Enumeration Date: 06/15/2007
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7111 E LOWRY BLVD STE 200
DENVER CO
80230-7360
US

IV. Provider business mailing address

7111 E LOWRY BLVD STE 200
DENVER CO
80230-7360
US

V. Phone/Fax

Practice location:
  • Phone: 303-394-2828
  • Fax: 303-320-0242
Mailing address:
  • Phone: 303-394-2828
  • Fax: 303-320-0242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number48030
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: