Provider Demographics
NPI:1437131547
Name:LARSEN, KARL MARTIN (MD)
Entity Type:Individual
Prefix:DR
First Name:KARL
Middle Name:MARTIN
Last Name:LARSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2446 RESEARCH PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-1087
Mailing Address - Country:US
Mailing Address - Phone:719-623-1050
Mailing Address - Fax:719-623-1052
Practice Address - Street 1:2446 RESEARCH PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-1087
Practice Address - Country:US
Practice Address - Phone:719-623-1050
Practice Address - Fax:719-623-1052
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY41401207X00000X, 207XS0106X
CO43404207X00000X, 207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO68003561Medicaid
KY7100048560Medicaid
H47287Medicare UPIN
KY7100048560Medicaid
KY0092760Medicare PIN