Provider Demographics
NPI:1205134350
Name:BRANDSTETTER, KIMBERLY (DO)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:
Last Name:BRANDSTETTER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9049
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-9049
Mailing Address - Country:US
Mailing Address - Phone:303-415-4101
Mailing Address - Fax:303-415-4769
Practice Address - Street 1:5495 ARAPAHOE AVE STE 100
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-1224
Practice Address - Country:US
Practice Address - Phone:303-415-4250
Practice Address - Fax:303-440-9629
Is Sole Proprietor?:No
Enumeration Date:2011-03-13
Last Update Date:2025-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A11539207R00000X
AZ006058207R00000X
CODR.0074250207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000245548Medicaid