Provider Demographics
NPI:1427041920
Name:LUBECK, KENDALL L (MD)
Entity Type:Individual
Prefix:DR
First Name:KENDALL
Middle Name:L
Last Name:LUBECK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:205 S GARRISON ST
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80226-2843
Mailing Address - Country:US
Mailing Address - Phone:720-728-5170
Mailing Address - Fax:303-730-1145
Practice Address - Street 1:7780 S BROADWAY
Practice Address - Street 2:SUITE 100
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80122-2648
Practice Address - Country:US
Practice Address - Phone:303-798-9996
Practice Address - Fax:303-730-1145
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO37900207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO11936860Medicaid
CO114679OtherAETNA HMO
CO7911022OtherAETNA PPO
CO84099770813OtherPACIFICARE
CO8500654003OtherCIGNA
CO8500654003OtherCIGNA