Healthcare Provider Details

I. General information

NPI: 1245184134
Provider Name (Legal Business Name): KYLE B LANDWEHR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2026
Last Update Date: 02/25/2026
Certification Date: 02/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 M ST
GREELEY CO
80631-9586
US

IV. Provider business mailing address

24100 E ALAMEDA AVE
AURORA CO
80018-1509
US

V. Phone/Fax

Practice location:
  • Phone: 970-347-2120
  • Fax:
Mailing address:
  • Phone: 720-234-6908
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: