Provider Demographics
NPI:1558553941
Name:SENNHOLZ, KELLY Z (MD)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:Z
Last Name:SENNHOLZ
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 1:2480 YATES ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80212-1349
Mailing Address - Country:US
Mailing Address - Phone:303-831-9252
Mailing Address - Fax:
Practice Address - Street 1:2480 YATES ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80212-1349
Practice Address - Country:US
Practice Address - Phone:303-831-9252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-10
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY6891A207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY6891AOtherSTATE MEDICAL LICENSE