Provider Demographics
NPI:1083652309
Name:PAGANO, KARI FREEMAN (MD)
Entity Type:Individual
Prefix:
First Name:KARI
Middle Name:FREEMAN
Last Name:PAGANO
Suffix:
Gender:F
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:FILE 56765
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90074-6765
Mailing Address - Country:US
Mailing Address - Phone:602-406-3860
Mailing Address - Fax:602-406-6132
Practice Address - Street 1:2803 ROSLYN ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80238-2624
Practice Address - Country:US
Practice Address - Phone:303-403-6300
Practice Address - Fax:303-406-6315
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2018-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ45332207Q00000X
CO55589207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ652217Medicaid
AZ652217Medicaid