Healthcare Provider Details

I. General information

NPI: 1972169100
Provider Name (Legal Business Name): JDE MEDICAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2019
Last Update Date: 06/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8721 E 52ND PL
DENVER CO
80238-3872
US

IV. Provider business mailing address

8721 E 52ND PL
DENVER CO
80238-3872
US

V. Phone/Fax

Practice location:
  • Phone: 303-594-6165
  • Fax:
Mailing address:
  • Phone: 303-594-6165
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. KAROLYN KABIR
Title or Position: MEMBER
Credential: MD
Phone: 303-594-6165