Provider Demographics
NPI:1114976669
Name:KASENBERG, THOMAS PAUL (DO)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:PAUL
Last Name:KASENBERG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:295 E 29TH ST
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-2743
Mailing Address - Country:US
Mailing Address - Phone:970-669-6000
Mailing Address - Fax:970-669-6002
Practice Address - Street 1:295 E 29TH ST
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-2743
Practice Address - Country:US
Practice Address - Phone:970-669-6000
Practice Address - Fax:970-669-6002
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO23248207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
84132889801OtherPACIFICARE
CO01232487Medicaid
841328898005OtherROCKY MOUNTAIN HEALTH PLA
84132889802OtherPACIFICARE
84132889801OtherSECURE HORIZONS
84132889802OtherSECURE HORIZONS
CO01232487Medicaid
84132889801OtherSECURE HORIZONS
COD28319Medicare UPIN