1023610888 NPI number — ADVANCED DERMATOLOGY SKIN CANCER & LASER SURGERY CENTER P.C.

Table of content: KATHERINE ANNA LUND LMFT (NPI 1437923497)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023610888 NPI number — ADVANCED DERMATOLOGY SKIN CANCER & LASER SURGERY CENTER P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED DERMATOLOGY SKIN CANCER & LASER SURGERY CENTER P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023610888
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/16/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3464 S. WILLOW STREET
Provider Second Line Business Mailing Address:
SUITE 194
Provider Business Mailing Address City Name:
DENVER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80231-4531
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-755-2900
Provider Business Mailing Address Fax Number:
303-755-0404

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12645 E. EUCLID DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CENTENNIAL
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80111-6437
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-493-1910
Provider Business Practice Location Address Fax Number:
303-493-1915
Provider Enumeration Date:
11/16/2020

Additional Information

Authorized Official

Authorized Official Last Name:
PAPALEAS
Authorized Official First Name:
GREGORY
Authorized Official Middle Name:
G
Authorized Official Title or Position:
DOCTOR OF OSTEOPATHIC MEDICINE
Authorized Official Telephone Number:
303-368-8611

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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