Provider Demographics
NPI:1467749978
Name:KONKLE, KATY (MD)
Entity Type:Individual
Prefix:
First Name:KATY
Middle Name:
Last Name:KONKLE
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:PO BOX 560825
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80256-0825
Mailing Address - Country:US
Mailing Address - Phone:719-595-7580
Mailing Address - Fax:719-545-0176
Practice Address - Street 1:3676 PARKER BLVD
Practice Address - Street 2:STE 280
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008-2214
Practice Address - Country:US
Practice Address - Phone:719-595-8505
Practice Address - Fax:719-595-8509
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-05
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0059044208800000X
NY316047208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology