Provider Demographics
NPI:1467439703
Name:LILJESTRAND, KARIN E (MD)
Entity Type:Individual
Prefix:
First Name:KARIN
Middle Name:E
Last Name:LILJESTRAND
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 1:6495 E HAPPY CANYON RD
Mailing Address - Street 2:APT 7
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-1148
Mailing Address - Country:US
Mailing Address - Phone:303-351-3667
Mailing Address - Fax:
Practice Address - Street 1:6495 E HAPPY CANYON RD
Practice Address - Street 2:APT 7
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80237-1148
Practice Address - Country:US
Practice Address - Phone:303-351-3667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO45327207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO61286036Medicaid
IN200105720Medicaid
CO61286036Medicaid
IN200105720Medicaid