Provider Demographics
NPI:1457317638
Name:FAIRBANKS, KYRSTEN D (MD)
Entity Type:Individual
Prefix:
First Name:KYRSTEN
Middle Name:D
Last Name:FAIRBANKS
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 1:499 E HAMPDEN AVE STE 420
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80113-2794
Mailing Address - Country:US
Mailing Address - Phone:303-788-8888
Mailing Address - Fax:866-896-1158
Practice Address - Street 1:499 E HAMPDEN AVE STE 420
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-2794
Practice Address - Country:US
Practice Address - Phone:303-788-8888
Practice Address - Fax:866-896-1158
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0052799207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO25072234Medicaid
CO336120YTPKMedicare PIN
OHFA7349481Medicare PIN