Provider Demographics
NPI:1063527653
Name:LOVE-OSBORNE, KATHRYN A (MD)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:A
Last Name:LOVE-OSBORNE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 BANNOCK ST
Mailing Address - Street 2:MC 7782
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80204-4507
Mailing Address - Country:US
Mailing Address - Phone:303-436-4688
Mailing Address - Fax:303-436-4665
Practice Address - Street 1:777 BANNOCK ST
Practice Address - Street 2:MC 7782
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-4507
Practice Address - Country:US
Practice Address - Phone:303-436-6000
Practice Address - Fax:303-436-4665
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO330812080A0000X, 208000000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO49607871Medicaid
CO49607871Medicaid
CO480478Medicare ID - Type Unspecified