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NPI Code Detail

MEDICARE: ALEXANDER OTIS KISOR

MEDICARE:   ALEXANDER OTIS KISOR
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
11041C0700XClinical Social WorkerCSW.09926977CO

General Provider Information

NPI Number : 1205435336
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALEXANDER OTIS KISOR
Provider Business Mailing Address
First Line : 116 INVERNESS DR E STE 105
Second Line :
City : ENGLEWOOD
State : CO
Zip : 80112-5125
Country : US
Telephone Number : 303-730-8858
Fax Number :
Provider Business Practice Location Address
First Line : 55 MADISON ST STE 240
Second Line :
City : DENVER
State : CO
Zip : 80206-5451
Country : US
Telephone Number : 970-310-3406
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/20/2020
Last Update Date : 11/18/2024

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Directions to “ ALEXANDER OTIS KISOR ” Practice Location

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