Provider Demographics
NPI:1144238767
Name:KRICH, MARK A (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:KRICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1241 W MINERAL AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80120-5685
Mailing Address - Country:US
Mailing Address - Phone:303-759-0854
Mailing Address - Fax:303-759-0864
Practice Address - Street 1:350 W THOMAS RD
Practice Address - Street 2:ST. JOSEPH'S HOSPITAL
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-4409
Practice Address - Country:US
Practice Address - Phone:602-406-3000
Practice Address - Fax:602-406-7165
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2010-08-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ29213207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ624032Medicaid
AZP00033439OtherRR MEDICARE
AZZ138672Medicare PIN
AZZ502438Medicare PIN
AZ624032Medicaid