Provider Demographics
NPI:1962409342
Name:KELLY, KAREN (MD)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:
Last Name:KELLY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:
Other - Last Name:KELLY-HEMLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1707 COLE BLVD
Mailing Address - Street 2:STE 100
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401-3220
Mailing Address - Country:US
Mailing Address - Phone:303-716-8013
Mailing Address - Fax:303-763-5495
Practice Address - Street 1:2801 YOUNGFIELD ST
Practice Address - Street 2:STE 120
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-2263
Practice Address - Country:US
Practice Address - Phone:720-898-9427
Practice Address - Fax:303-302-0808
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO29388207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01293885Medicaid
CON1914Medicare ID - Type Unspecified
CO01293885Medicaid