NPI 1104223239 · Physician · Kpic
Strong multi-source corroboration of active practice across 2 carrier networks with confirmed Colorado DORA license.
NPPES
BOULDER, 80304
Freshness: Unknown
Network Status
Listed with 2 carriers
DORA License
Active
Medicare
Non-Medicare specialty
Care Compare
No Care Compare data
PECOS Enrollment
No PECOS data
Active NPI with specialty classification
Active Colorado DORA license confirmed
No Medicare billing · No electronic endpoint · No PECOS enrollment
Single address source (NPPES)
Limited carrier network presence
2 networks across 1 carrier
Disclaimer: This analysis uses publicly available federal and state data sources. It does not constitute a determination of provider status or network participation. Contact the provider or health plan directly to verify current status.