Provider Demographics
NPI:1568668853
Name:BENTROTT, KIMBERLY ERIN (MD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ERIN
Last Name:BENTROTT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:ERIN
Other - Last Name:DUNBACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:32214 ELLINGWOOD TRL
Mailing Address - Street 2:STE 210
Mailing Address - City:EVERGREEN
Mailing Address - State:CO
Mailing Address - Zip Code:80439-9779
Mailing Address - Country:US
Mailing Address - Phone:303-679-2020
Mailing Address - Fax:303-670-2160
Practice Address - Street 1:32214 ELLINGWOOD TRL
Practice Address - Street 2:STE 210
Practice Address - City:EVERGREEN
Practice Address - State:CO
Practice Address - Zip Code:80439-9779
Practice Address - Country:US
Practice Address - Phone:303-679-2020
Practice Address - Fax:303-670-2160
Is Sole Proprietor?:No
Enumeration Date:2007-06-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO45155207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO25621084Medicaid
COFB0092647OtherDEA