Provider Demographics
NPI:1154385367
Name:KIRCHER, MARK H (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:H
Last Name:KIRCHER
Suffix:
Gender:M
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 1:575 RIVERGATE LANE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:87301
Mailing Address - Country:US
Mailing Address - Phone:970-259-3020
Mailing Address - Fax:970-259-9766
Practice Address - Street 1:575 RIVERGATE LANE
Practice Address - Street 2:SUITE 105
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301
Practice Address - Country:US
Practice Address - Phone:970-259-3020
Practice Address - Fax:970-259-9766
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO33198207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01331982Medicaid
CO01331982Medicaid
B23982Medicare UPIN