Provider Demographics
NPI:1609172782
Name:SCHLUP, KEYNA I (MD)
Entity Type:Individual
Prefix:
First Name:KEYNA
Middle Name:I
Last Name:SCHLUP
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 1:428 S 2ND ST
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:CO
Mailing Address - Zip Code:80751-4219
Mailing Address - Country:US
Mailing Address - Phone:406-212-4523
Mailing Address - Fax:402-337-8898
Practice Address - Street 1:428 S 2ND ST
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:CO
Practice Address - Zip Code:80751
Practice Address - Country:US
Practice Address - Phone:406-212-4523
Practice Address - Fax:402-337-8898
Is Sole Proprietor?:No
Enumeration Date:2011-02-07
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR0052853207Q00000X
WY9070A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO66684331Medicaid