Provider Demographics
NPI:1598045346
Name:KEIM, CAROLE ANNE (MD)
Entity Type:Individual
Prefix:
First Name:CAROLE
Middle Name:ANNE
Last Name:KEIM
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:PO BOX 3350
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80307-3350
Mailing Address - Country:US
Mailing Address - Phone:720-418-1705
Mailing Address - Fax:
Practice Address - Street 1:4985 MOORHEAD AVE UNIT 3350
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80307-4816
Practice Address - Country:US
Practice Address - Phone:720-418-1705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-25
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO53260208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics