MEDICARE: KATHLEEN MARIE RUSTICI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	51637	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003089293
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN MARIE RUSTICI M.D.

Provider Business Mailing Address
First Line	:	12631 E 17TH AVE
Second Line	:	PO BOX 6511
City	:	AURORA
State	:	CO
Zip	:	80045-2527
Country	:	US
Telephone Number	:	303-724-2052
Fax Number	:

Provider Business Practice Location Address
First Line	:	2807 ROSLYN ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80238-2624
Country	:	US
Telephone Number	:	303-403-6333
Fax Number	:	303-403-6325

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/08/2008
Last Update Date	:	01/31/2013

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