Provider Demographics
NPI:1477568962
Name:KORNREICH, CAROLE SUE (MD)
Entity Type:Individual
Prefix:DR
First Name:CAROLE
Middle Name:SUE
Last Name:KORNREICH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:950 WADSWORTH BLVD
Mailing Address - Street 2:#206
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80214-4542
Mailing Address - Country:US
Mailing Address - Phone:303-237-1829
Mailing Address - Fax:303-237-1023
Practice Address - Street 1:950 WADSWORTH BLVD
Practice Address - Street 2:#206
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80214-4542
Practice Address - Country:US
Practice Address - Phone:303-237-1829
Practice Address - Fax:303-237-1023
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO198492084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
E89652Medicare UPIN
50291Medicare ID - Type Unspecified