Provider Demographics
NPI:1720343890
Name:DEAVER, KELSI E (MD)
Entity type:Individual
Prefix:
First Name:KELSI
Middle Name:E
Last Name:DEAVER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1960 OGDEN ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-3666
Mailing Address - Country:US
Mailing Address - Phone:303-318-1540
Mailing Address - Fax:303-318-2481
Practice Address - Street 1:799 E HAMPDEN AVE STE 525
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113
Practice Address - Country:US
Practice Address - Phone:303-321-2466
Practice Address - Fax:303-321-2446
Is Sole Proprietor?:No
Enumeration Date:2012-07-05
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0060766207RE0101X
COTL-4370390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program