=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215913710
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SUSAN B KIRELIK M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/16/2005
-----------------------------------------------------
Last Update Date | 11/02/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5600 S QUEBEC ST SUITE 312A
-----------------------------------------------------
City | GREENWOOD VILLAGE
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80111-2207
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-436-2727
-----------------------------------------------------
Fax | 303-436-2710
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5600 S QUEBEC ST SUITE 312A
-----------------------------------------------------
City | GREENWOOD VILLAGE
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80111-2207
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-436-2727
-----------------------------------------------------
Fax | 303-436-2710
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207P00000X
-----------------------------------------------------
Taxonomy Name | Emergency Medicine Physician
-----------------------------------------------------
License Number | 33924
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------