MEDICARE: KIMBERLY ERIN BENTROTT 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	45155	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	:	1568668853
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY ERIN BENTROTT M.D.

Provider Business Mailing Address
First Line	:	32214 ELLINGWOOD TRL
Second Line	:	STE 210
City	:	EVERGREEN
State	:	CO
Zip	:	80439-9779
Country	:	US
Telephone Number	:	303-679-2020
Fax Number	:	303-670-2160

Provider Business Practice Location Address
First Line	:	32214 ELLINGWOOD TRL
Second Line	:	STE 210
City	:	EVERGREEN
State	:	CO
Zip	:	80439-9779
Country	:	US
Telephone Number	:	303-679-2020
Fax Number	:	303-670-2160

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

Provider Enumeration Date	:	06/22/2007
Last Update Date	:	03/07/2023

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