Healthcare Provider Details

I. General information

NPI: 1891740932
Provider Name (Legal Business Name): KATHLEEN D'ANGELO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 04/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12207 PECOS ST SUITE 300
WESTMINSTER CO
80234-3400
US

IV. Provider business mailing address

4900 S MONACO ST SUITE 210
DENVER CO
80237-3486
US

V. Phone/Fax

Practice location:
  • Phone: 303-650-0445
  • Fax: 303-429-5088
Mailing address:
  • Phone: 303-650-0445
  • Fax: 303-429-5088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License Number39012
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: