Provider Demographics
NPI:1245430826
Name:KEMMIS, TYLER J (MD)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:J
Last Name:KEMMIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:500 ELDORADO BLVD
Mailing Address - Street 2:SUITE 6250
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80021-3408
Mailing Address - Country:US
Mailing Address - Phone:303-272-0750
Mailing Address - Fax:303-318-2488
Practice Address - Street 1:8300 W 38TH AVE
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-6005
Practice Address - Country:US
Practice Address - Phone:303-467-8903
Practice Address - Fax:303-467-8921
Is Sole Proprietor?:No
Enumeration Date:2007-07-20
Last Update Date:2013-12-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO487202085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO83178279Medicaid
COCOA102384Medicare PIN