MEDICARE: KATHY FINE MCCRANIE MD PROF LLC

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	208100000X	Physical Medicine & Rehabilitation Physician	30645	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
2	KA670691	OTHER		BC/BS

General Provider Information

NPI Number	:	1396776993
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KATHY FINE MCCRANIE MD PROF LLC

Provider Business Mailing Address
First Line	:	PO BOX 17794
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80217-0794
Country	:	US
Telephone Number	:	800-968-6866
Fax Number	:	616-532-7230

Provider Business Practice Location Address
First Line	:	1380 S SANTA FE DR
Second Line	:	SUITE 100
City	:	DENVER
State	:	CO
Zip	:	80223-3216
Country	:	US
Telephone Number	:	303-777-3425
Fax Number	:	303-777-3425

Authorized Official
Title or Position	:	OWNER
Name	:	KATHY FINE MCCRANIE
Credential	:	MD
Telephone Number	:	303-777-3422

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	01/14/2008

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