Provider Demographics
NPI:1962615732
Name:KAFUUMA, ROLAND K (MD)
Entity type:Individual
Prefix:DR
First Name:ROLAND
Middle Name:K
Last Name:KAFUUMA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 MOUNTAIN VIEW AVE
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-3129
Mailing Address - Country:US
Mailing Address - Phone:303-651-5111
Mailing Address - Fax:303-586-8206
Practice Address - Street 1:1950 MOUNTAIN VIEW AVE STE 250
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-3129
Practice Address - Country:US
Practice Address - Phone:303-651-5111
Practice Address - Fax:303-485-4240
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCDRH.0048370208M00000X
CO48370207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO5910328Medicaid
CO5910328Medicaid
COCOA10161Medicare PIN