1568566974 NPI number — DR. KARRIN BORCHARD MEZARINA MD

Table of content: DR. KARRIN BORCHARD MEZARINA MD (NPI 1568566974)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568566974 NPI number — DR. KARRIN BORCHARD MEZARINA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MEZARINA
Provider First Name:
KARRIN
Provider Middle Name:
BORCHARD
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BORCHARD
Provider Other First Name:
KARRIN
Provider Other Middle Name:
NICOLE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1568566974
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
90 HEALTH PARK DR
Provider Second Line Business Mailing Address:
#160
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80027
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-673-9030
Provider Business Mailing Address Fax Number:
303-604-1095

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
90 HEALTH PARK DR
Provider Second Line Business Practice Location Address:
#160
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80027
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-673-9030
Provider Business Practice Location Address Fax Number:
303-604-1095
Provider Enumeration Date:
09/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  42452 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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