Provider Demographics
NPI:1558619411
Name:TKMD LLC
Entity Type:Organization
Organization Name:TKMD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:KRUSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-927-8563
Mailing Address - Street 1:1460 E VALLEY RD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:BASALT
Mailing Address - State:CO
Mailing Address - Zip Code:81621-8411
Mailing Address - Country:US
Mailing Address - Phone:970-927-8563
Mailing Address - Fax:970-208-1675
Practice Address - Street 1:1460 E VALLEY RD
Practice Address - Street 2:SUITE 160
Practice Address - City:BASALT
Practice Address - State:CO
Practice Address - Zip Code:81621-8411
Practice Address - Country:US
Practice Address - Phone:970-927-8563
Practice Address - Fax:970-208-1675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-27
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO37271207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty