MEDICARE: KELLY Z SENNHOLZ MD

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	207P00000X	Emergency Medicine Physician	6891A	WY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	6891A	OTHER	WY	STATE MEDICAL LICENSE

General Provider Information

NPI Number	:	1558553941
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY Z SENNHOLZ MD

Provider Business Mailing Address
First Line	:	2480 YATES ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80212-1349
Country	:	US
Telephone Number	:	303-831-9252
Fax Number	:

Provider Business Practice Location Address
First Line	:	2480 YATES ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80212-1349
Country	:	US
Telephone Number	:	303-831-9252
Fax Number	:

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

Provider Enumeration Date	:	08/10/2007
Last Update Date	:	08/23/2007

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