MEDICARE: DR. KENNETH S GREENBERG D.O.

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	207RI0200X	Infectious Disease Physician	32546	CO

General Provider Information

NPI Number	:	1972587228
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH S GREENBERG D.O.

Provider Business Mailing Address
First Line	:	4545 E 9TH AVE
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80220-3902
Country	:	US
Telephone Number	:	303-393-8050
Fax Number	:	303-320-1953

Provider Business Practice Location Address
First Line	:	4545 E 9TH AVE
Second Line	:	SUITE 120
City	:	DENVER
State	:	CO
Zip	:	80220-3901
Country	:	US
Telephone Number	:	303-393-8050
Fax Number	:	303-320-1953

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

Provider Enumeration Date	:	11/30/2005
Last Update Date	:	12/29/2009

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