Provider Demographics
NPI:1215913710
Name:KIRELIK, SUSAN B (MD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:B
Last Name:KIRELIK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:5600 S QUEBEC ST
Mailing Address - Street 2:SUITE 312A
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-2207
Mailing Address - Country:US
Mailing Address - Phone:303-436-2727
Mailing Address - Fax:303-436-2710
Practice Address - Street 1:5600 S QUEBEC ST
Practice Address - Street 2:SUITE 312A
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-2207
Practice Address - Country:US
Practice Address - Phone:303-436-2727
Practice Address - Fax:303-436-2710
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO33924207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01339241Medicaid
COE50067Medicare ID - Type Unspecified
COF99750Medicare UPIN