Provider Demographics
NPI:1134650252
Name:MADUREIRA, BARI
Entity Type:Individual
Prefix:
First Name:BARI
Middle Name:
Last Name:MADUREIRA
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:BARI
Other - Middle Name:
Other - Last Name:KILCOYNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPH
Mailing Address - Street 1:8101 E LOWRY BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80230-7195
Mailing Address - Country:US
Mailing Address - Phone:720-865-6072
Mailing Address - Fax:
Practice Address - Street 1:3 SUPERIOR DR STE 225
Practice Address - Street 2:
Practice Address - City:SUPERIOR
Practice Address - State:CO
Practice Address - Zip Code:80027-8661
Practice Address - Country:US
Practice Address - Phone:303-665-2603
Practice Address - Fax:303-665-2605
Is Sole Proprietor?:No
Enumeration Date:2017-03-21
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CODR.0069021207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program