MEDICARE: MR. BRIAN KAIRALLA PA-C

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	363AM0700X	Medical Physician Assistant	PA.0004861	CO

General Provider Information

NPI Number	:	1033499553
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRIAN KAIRALLA PA-C

Provider Business Mailing Address
First Line	:	3455 RINGSBY CT STE 102
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80216-4923
Country	:	US
Telephone Number	:	300-500-1518
Fax Number	:

Provider Business Practice Location Address
First Line	:	3455 RINGSBY CT STE 102
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80216-4923
Country	:	US
Telephone Number	:	300-500-1518
Fax Number	:

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

Provider Enumeration Date	:	08/29/2011
Last Update Date	:	01/17/2017

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