Provider Demographics
NPI:1376504670
Name:WEISIGER, KENNETH HOOPER (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:HOOPER
Last Name:WEISIGER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:14062 DENVER WEST PKWY BLDG 52
Mailing Address - Street 2:STE 150
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80401-3187
Mailing Address - Country:US
Mailing Address - Phone:719-457-6200
Mailing Address - Fax:303-825-7927
Practice Address - Street 1:14062 DENVER WEST PKWY BLDG 52
Practice Address - Street 2:STE 150
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80401-3187
Practice Address - Country:US
Practice Address - Phone:719-457-6200
Practice Address - Fax:303-825-7927
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-28
Last Update Date:2020-06-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO22327207R00000X, 207RP1001X
CODR.0022327207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1223270Medicaid
COC305318OtherMEDICARE PTAN
CO1223270Medicaid