Provider Demographics
NPI:1528529732
Name:PAULA KADISON, MD PC
Entity type:Organization
Organization Name:PAULA KADISON, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:KADISON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-379-1240
Mailing Address - Street 1:PO BOX 481
Mailing Address - Street 2:
Mailing Address - City:WOODY CREEK
Mailing Address - State:CO
Mailing Address - Zip Code:81656-0481
Mailing Address - Country:US
Mailing Address - Phone:970-379-1240
Mailing Address - Fax:970-925-2597
Practice Address - Street 1:100 E MAIN ST STE 2
Practice Address - Street 2:
Practice Address - City:ASPEN
Practice Address - State:CO
Practice Address - Zip Code:81611-1780
Practice Address - Country:US
Practice Address - Phone:970-379-1240
Practice Address - Fax:970-925-2597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-29
Last Update Date:2019-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO48917OtherCOLORADO MEDICAL BOARD