Provider Demographics
NPI:1972169100
Name:JDE MEDICAL PLLC
Entity type:Organization
Organization Name:JDE MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:KABIR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-594-6165
Mailing Address - Street 1:8721 E 52ND PL
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80238-3872
Mailing Address - Country:US
Mailing Address - Phone:303-594-6165
Mailing Address - Fax:
Practice Address - Street 1:8721 E 52ND PL
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80238-3872
Practice Address - Country:US
Practice Address - Phone:303-594-6165
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-14
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty