Provider Demographics
NPI:1003866880
Name:BREKHUS, KIT K (MD)
Entity Type:Individual
Prefix:DR
First Name:KIT
Middle Name:K
Last Name:BREKHUS
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 1:750 W HAMPDEN AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80110-2167
Mailing Address - Country:US
Mailing Address - Phone:508-213-1947
Mailing Address - Fax:
Practice Address - Street 1:20270 E SMOKY HILL RD
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80015-3138
Practice Address - Country:US
Practice Address - Phone:303-680-0664
Practice Address - Fax:303-693-2043
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO30901207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1309012Medicaid
CO080165388OtherRR MEDICARE
COBR31982OtherBLUE SHIELD
COBRA31982OtherBLUE SHIELD
COBR31982OtherBLUE SHIELD
COC450578Medicare PIN
COP00222536OtherRR MEDICARE