1316061047 NPI number — HOWARD J KERSTEIN MD PC

Table of content: (NPI 1316061047)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316061047 NPI number — HOWARD J KERSTEIN MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOWARD J KERSTEIN MD PC
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:
1316061047
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3464 S WILLOW ST
Provider Second Line Business Mailing Address:
SUITE 345
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:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3865 CHERRY CREEK DRIVE NORTH
Provider Second Line Business Practice Location Address:
SUITE 322
Provider Business Practice Location Address City Name:
DENVER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80209
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-394-2888
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KERSTEIN
Authorized Official First Name:
HOWARD
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
303-394-2888

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 04017299 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: HOM4508 . This is a "BLUE SHIELD" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




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