Provider Demographics
NPI:1356450431
Name:SAMPERA, KIRSTEN MARLENE HEIDEL (MD)
Entity Type:Individual
Prefix:DR
First Name:KIRSTEN
Middle Name:MARLENE HEIDEL
Last Name:SAMPERA
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 1:1200 E ELIZABETH ST
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-4007
Mailing Address - Country:US
Mailing Address - Phone:970-267-9510
Mailing Address - Fax:970-482-6938
Practice Address - Street 1:1200 E ELIZABETH ST
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-4007
Practice Address - Country:US
Practice Address - Phone:970-267-9510
Practice Address - Fax:970-482-6938
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0045608208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO00531766Medicaid
CA00A405490Medicaid
CAI00661Medicare UPIN
CAGR0053510Medicaid
CAWA82002AMedicare ID - Type Unspecified