Provider Demographics
NPI:1427491570
Name:SPECKMAN, KATHERINE STARR WIEGERT (MD)
Entity type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:STARR WIEGERT
Last Name:SPECKMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:STARR
Other - Last Name:WIEGERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1735 S PUBLIC RD STE 203
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-7093
Mailing Address - Country:US
Mailing Address - Phone:303-665-3036
Mailing Address - Fax:303-665-3397
Practice Address - Street 1:8510 BRYANT ST
Practice Address - Street 2:STE 200
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80031-3844
Practice Address - Country:US
Practice Address - Phone:303-650-4460
Practice Address - Fax:303-565-4130
Is Sole Proprietor?:No
Enumeration Date:2013-04-09
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR0057283207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO39125033Medicaid
CO029529OtherKAISER COMMERCIAL NUMBER