MEDICARE: DR. KAREN KELLY 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	207R00000X	Internal Medicine Physician	29388	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	:	1962409342
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KAREN KELLY M.D.

Provider Business Mailing Address
First Line	:	1707 COLE BLVD
Second Line	:	STE 100
City	:	GOLDEN
State	:	CO
Zip	:	80401-3220
Country	:	US
Telephone Number	:	303-716-8013
Fax Number	:	303-763-5495

Provider Business Practice Location Address
First Line	:	2801 YOUNGFIELD ST
Second Line	:	STE 120
City	:	GOLDEN
State	:	CO
Zip	:	80401-2263
Country	:	US
Telephone Number	:	720-898-9427
Fax Number	:	303-302-0808

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

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	10/04/2013

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