Healthcare Provider Details

I. General information

NPI: 1265591895
Provider Name (Legal Business Name): KIMBERLY LYNNE SIEGEL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 05/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4674 SNOW MESA DR SUITE 200
FORT COLLINS CO
80528-8615
US

IV. Provider business mailing address

4674 SNOW MESA DR SUITE 200
FORT COLLINS CO
80528-8615
US

V. Phone/Fax

Practice location:
  • Phone: 970-495-8450
  • Fax: 970-297-6599
Mailing address:
  • Phone: 970-495-8450
  • Fax: 970-297-6599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberA84994
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number12556
License Number StateMT
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberDR.0055719
License Number StateCO
# 5
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberDR.0055719
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: