Provider Demographics
NPI:1356317457
Name:MCDIVITT, E KAY (MD)
Entity Type:Individual
Prefix:
First Name:E KAY
Middle Name:
Last Name:MCDIVITT
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 1:8505 E ALAMEDA AVE UNIT 3129
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80230-6068
Mailing Address - Country:US
Mailing Address - Phone:303-619-7444
Mailing Address - Fax:
Practice Address - Street 1:8505 E ALAMEDA AVE UNIT 3129
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80230-6068
Practice Address - Country:US
Practice Address - Phone:303-619-7444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-27
Last Update Date:2015-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO26895207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01268952Medicaid
CO01268952Medicaid
CO01268952Medicaid