Healthcare Provider Details

I. General information

NPI: 1811123474
Provider Name (Legal Business Name): KARL AUGUST KAMM PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: KARL AUGUST KAMM PHYSICIAN ASSISTANT

II. Dates (important events)

Enumeration Date: 06/09/2009
Last Update Date: 07/13/2023
Certification Date: 07/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 S RIO GRANDE AVE
MONTROSE CO
81401-4831
US

IV. Provider business mailing address

PO BOX 529
OLATHE CO
81425-0529
US

V. Phone/Fax

Practice location:
  • Phone: 970-497-3333
  • Fax: 855-299-7837
Mailing address:
  • Phone: 970-323-6141
  • Fax: 855-299-8071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.0003902
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA2009-0006
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: