NPI 1245446954 · Physician · Kpic
Carrier listings present but Colorado DORA license appears expired or revoked.
NPPES
LAKEWOOD, 80226
Freshness: Unknown
Network Status
Listed with 2 carriers
DORA License
Expired
Medicare
Non-Medicare specialty
Care Compare
No Care Compare data
PECOS Enrollment
No PECOS data
Active NPI with specialty classification
DORA license expired or revoked
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.