Provider Demographics
NPI:1356326300
Name:KURICA, KENNETH BOOTH (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:BOOTH
Last Name:KURICA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5390 N ACADEMY BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-4062
Mailing Address - Country:US
Mailing Address - Phone:719-596-6110
Mailing Address - Fax:719-596-6112
Practice Address - Street 1:5390 N ACADEMY BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-4062
Practice Address - Country:US
Practice Address - Phone:719-596-6110
Practice Address - Fax:719-596-6112
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO23258207XS0117X, 247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01232586Medicaid
CO01232586Medicaid
COCOB4202Medicare PIN
COS2108Medicare PIN