Provider Demographics
NPI:1306028246
Name:KAREN J SUNDBY MD, PC
Entity Type:Organization
Organization Name:KAREN J SUNDBY MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:SUNDBY
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PC
Authorized Official - Phone:303-388-8807
Mailing Address - Street 1:4700 HALE PARKWAY
Mailing Address - Street 2:SUITE 140
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-4050
Mailing Address - Country:US
Mailing Address - Phone:303-388-8807
Mailing Address - Fax:303-962-0315
Practice Address - Street 1:4700 HALE PARKWAY
Practice Address - Street 2:SUITE 140
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-4050
Practice Address - Country:US
Practice Address - Phone:303-388-8807
Practice Address - Fax:303-962-0315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-03
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO41658207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC805167OtherMEDICARE GROUP #
COI33509Medicare UPIN