Provider Demographics
NPI:1316932759
Name:MOLK, KEVIN JONATHAN (MD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:JONATHAN
Last Name:MOLK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9397 CROWN CREST BLVD
Mailing Address - Street 2:STE 420
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80138-8789
Mailing Address - Country:US
Mailing Address - Phone:303-770-0500
Mailing Address - Fax:303-220-5053
Practice Address - Street 1:9397 CROWN CREST BLVD
Practice Address - Street 2:STE 420
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80138-8789
Practice Address - Country:US
Practice Address - Phone:303-770-0500
Practice Address - Fax:303-220-5053
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2017-05-04
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-04-03
Provider Licenses
StateLicense IDTaxonomies
CODR.0020867207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
COD23844Medicare UPIN
COCB4718Medicare ID - Type Unspecified