Provider Demographics
NPI:1154307973
Name:BOEHNKE, KATHRYN L (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:L
Last Name:BOEHNKE
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:PO BOX 727
Mailing Address - Street 2:115 MOUNTAIN VIEW DR
Mailing Address - City:OURAY
Mailing Address - State:CO
Mailing Address - Zip Code:81427-0727
Mailing Address - Country:US
Mailing Address - Phone:970-325-4390
Mailing Address - Fax:
Practice Address - Street 1:115 MOUNTAIN VIEW DR
Practice Address - Street 2:
Practice Address - City:OURAY
Practice Address - State:CO
Practice Address - Zip Code:81427-0727
Practice Address - Country:US
Practice Address - Phone:970-325-4390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2009-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO382222085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO61176583Medicaid
CO801925Medicare ID - Type UnspecifiedDIA MCRE
CO801926Medicare ID - Type UnspecifiedMIC MCRE
COCO303189Medicare PIN
COH36442Medicare UPIN
CO801879Medicare ID - Type UnspecifiedRIA MCRE