Healthcare Provider Details

I. General information

NPI: 1861953556
Provider Name (Legal Business Name): KEVIN A SHAPIRO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2019
Last Update Date: 11/19/2025
Certification Date: 11/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W 16TH ST
PUEBLO CO
81003-2745
US

IV. Provider business mailing address

2695 ROCKY MOUNTAIN AVE
LOVELAND CO
80538-8702
US

V. Phone/Fax

Practice location:
  • Phone: 719-584-4000
  • Fax:
Mailing address:
  • Phone: 970-624-2403
  • Fax: 970-490-4173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number0069069
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberDR.0069069
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberDR.0069069
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberDR.0069069
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: