Provider Demographics
NPI:1396372348
Name:YAMAMURA, MINAMI KATIE (MD)
Entity Type:Individual
Prefix:
First Name:MINAMI
Middle Name:KATIE
Last Name:YAMAMURA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MINAMI
Other - Middle Name:K
Other - Last Name:YAMAMURA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:KATIE YAMAMURA
Mailing Address - Street 1:PO BOX 110429
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80042-0429
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12605 E 16TH AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-2545
Practice Address - Country:US
Practice Address - Phone:720-848-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-26
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COTL.0008171207RA0000X
CODR.0070836208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine