MEDICARE: KENYON JOSEPH WEIDLE 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	207Q00000X	Family Medicine Physician	49856	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	:	1083903165
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENYON JOSEPH WEIDLE M.D.

Provider Business Mailing Address
First Line	:	191 E ORCHARD RD STE 300
Second Line	:
City	:	LITTLETON
State	:	CO
Zip	:	80121-8058
Country	:	US
Telephone Number	:	303-788-3100
Fax Number	:	303-788-3197

Provider Business Practice Location Address
First Line	:	601 E HAMPDEN AVE STE 470
Second Line	:
City	:	ENGLEWOOD
State	:	CO
Zip	:	80113-2797
Country	:	US
Telephone Number	:	303-788-3100
Fax Number	:	303-788-3196

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

Provider Enumeration Date	:	03/29/2011
Last Update Date	:	12/29/2021

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Directions to “ KENYON JOSEPH WEIDLE M.D.” Practice Location

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