Provider Demographics
NPI:1164022240
Name:DK SPEEDIE MD LLC
Entity Type:Organization
Organization Name:DK SPEEDIE MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:SPEEDIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-250-2459
Mailing Address - Street 1:8568 COFFEY RD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:CO
Mailing Address - Zip Code:81410-8349
Mailing Address - Country:US
Mailing Address - Phone:970-250-2459
Mailing Address - Fax:
Practice Address - Street 1:11485 HIGHWAY 65
Practice Address - Street 2:
Practice Address - City:ECKERT
Practice Address - State:CO
Practice Address - Zip Code:81418-5204
Practice Address - Country:US
Practice Address - Phone:970-250-2459
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty