Provider Demographics
NPI:1962089961
Name:FEUSTEL, KAVANYA (MD)
Entity type:Individual
Prefix:DR
First Name:KAVANYA
Middle Name:
Last Name:FEUSTEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KAVANYA
Other - Middle Name:
Other - Last Name:GRAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10099 RIDGEGATE PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-5532
Mailing Address - Country:US
Mailing Address - Phone:720-875-2880
Mailing Address - Fax:720-875-2877
Practice Address - Street 1:10101 RIDGEGATE PKWY
Practice Address - Street 2:
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-5522
Practice Address - Country:US
Practice Address - Phone:720-402-7914
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-25
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COTL.0008726207R00000X
CO0069107208D00000X
CODR.0069107208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine