Provider Demographics
NPI:1104876721
Name:KRAFT, STEPHANIE KAKOS (MD)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:KAKOS
Last Name:KRAFT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10371 PARKGLENN WAY
Mailing Address - Street 2:STE 230
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80138-3885
Mailing Address - Country:US
Mailing Address - Phone:303-269-2525
Mailing Address - Fax:303-269-2520
Practice Address - Street 1:10371 PARKGLENN WAY
Practice Address - Street 2:STE 230
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80138-3885
Practice Address - Country:US
Practice Address - Phone:303-269-2525
Practice Address - Fax:303-269-2520
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO42358207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04021804Medicaid
CO541958Medicare ID - Type Unspecified
CO04021804Medicaid