Provider Demographics
NPI:1477577153
Name:ANTON-SCHNELL, KRISTINA A (MD)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:A
Last Name:ANTON-SCHNELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KRISTINA
Other - Middle Name:A
Other - Last Name:ANTONSSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4745 JAMESTON ST
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-4222
Mailing Address - Country:US
Mailing Address - Phone:720-582-1212
Mailing Address - Fax:720-405-4268
Practice Address - Street 1:7490 CLUBHOUSE RD # 105
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-3720
Practice Address - Country:US
Practice Address - Phone:720-582-1212
Practice Address - Fax:720-405-4268
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0044880207R00000X
CT44430207R00000X
CO44880207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO29751748Medicaid
CO29751748Medicaid
COP01172073Medicare PIN
CO260893YLL6Medicare PIN
COI60536Medicare UPIN
COC806228Medicare PIN