Provider Demographics
NPI:1215117940
Name:COWIE, KATHLEEN C (MD)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:C
Last Name:COWIE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KATHLEEN
Other - Middle Name:A
Other - Last Name:CEVASCO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:203 S ROLLIE AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LUPTON
Mailing Address - State:CO
Mailing Address - Zip Code:80621-1508
Mailing Address - Country:US
Mailing Address - Phone:303-286-4560
Mailing Address - Fax:303-286-4589
Practice Address - Street 1:360 PEAK ONE DRIVE, SUITE 100
Practice Address - Street 2:SUITE 100
Practice Address - City:FRISCO
Practice Address - State:CO
Practice Address - Zip Code:80443-4337
Practice Address - Country:US
Practice Address - Phone:970-668-4040
Practice Address - Fax:970-668-6699
Is Sole Proprietor?:No
Enumeration Date:2007-11-09
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0045881207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO36587567Medicaid
C0305980Medicare PIN