Healthcare Provider Details

I. General information

NPI: 1134424963
Provider Name (Legal Business Name): KATHARINE MEDDLES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2011
Last Update Date: 09/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2055 N HIGH ST STE 210
DENVER CO
80205-5507
US

IV. Provider business mailing address

2055 N HIGH ST STE 210
DENVER CO
80205-5507
US

V. Phone/Fax

Practice location:
  • Phone: 303-226-7230
  • Fax: 866-401-9731
Mailing address:
  • Phone: 303-226-7230
  • Fax: 866-401-9731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA115350
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number0061537
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License NumberA115350
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number2012021750
License Number StateMO
# 5
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number2012021750
License Number StateMO
# 6
Primary TaxonomyN
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License Number2012021750
License Number StateMO
# 7
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License NumberDR.0061537
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: