Provider Demographics
NPI:1245388529
Name:KISTLER, DAVID WALTER (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:WALTER
Last Name:KISTLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:720 S COLORADO BLVD
Mailing Address - Street 2:SUITE 220A
Mailing Address - City:GLENDALE
Mailing Address - State:CO
Mailing Address - Zip Code:80246-1912
Mailing Address - Country:US
Mailing Address - Phone:303-584-8231
Mailing Address - Fax:866-210-0907
Practice Address - Street 1:5044 W 92ND AVE
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80031-6301
Practice Address - Country:US
Practice Address - Phone:303-650-0445
Practice Address - Fax:303-429-5088
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO44166207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO348308OtherMEDICARE GROUP NUMBER
COC811604OtherMEDICARE GROUP NUMBER
COB30983Medicare UPIN
CO348308OtherMEDICARE GROUP NUMBER
COC811746Medicare PIN