Provider Demographics
NPI:1457488439
Name:MAYER, KATHLEEN W (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:W
Last Name:MAYER
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 1:6410 S QUAY CT
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80123-3608
Mailing Address - Country:US
Mailing Address - Phone:303-249-7335
Mailing Address - Fax:
Practice Address - Street 1:3513 BRIGHTON BLVD STE 230
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80216-3606
Practice Address - Country:US
Practice Address - Phone:720-689-5269
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO37902207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO13034871Medicaid
CO011804OtherKAISER COMMERCIAL NUMBER
COCK10980Medicare PIN
COH25116Medicare UPIN