Provider Demographics
NPI:1558417154
Name:BERMAN, KATHRYN LIEBER (MD)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:LIEBER
Last Name:BERMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:
Other - Last Name:LIEBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1100 FEDERAL BLVD
Mailing Address - Street 2:WESTSIDE ADULT CLINIC
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80204-3219
Mailing Address - Country:US
Mailing Address - Phone:303-436-4200
Mailing Address - Fax:
Practice Address - Street 1:1100 FEDERAL BLVD
Practice Address - Street 2:WESTSIDE FAMILY HEALTH CENTER
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-3219
Practice Address - Country:US
Practice Address - Phone:303-436-4202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO47785207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO59236299Medicaid