Provider Demographics
NPI:1487212452
Name:RYTLEWSKI, KACIE CORNELIUS (MD)
Entity Type:Individual
Prefix:
First Name:KACIE
Middle Name:CORNELIUS
Last Name:RYTLEWSKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KACIE
Other - Middle Name:TAYLOR
Other - Last Name:CORNELIUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13123 E 16TH AVE DEPT OF
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80045-7106
Mailing Address - Country:US
Mailing Address - Phone:720-777-1234
Mailing Address - Fax:
Practice Address - Street 1:13123 E 16TH AVE DEPT OF
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-7106
Practice Address - Country:US
Practice Address - Phone:720-777-1234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-04
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0071982208000000X
IAMD-49650208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics