Provider Demographics
NPI:1609188358
Name:KADIVAR, FATEMEH (MD)
Entity Type:Individual
Prefix:DR
First Name:FATEMEH
Middle Name:
Last Name:KADIVAR
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 1:1819 DENVER WEST DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80401-3118
Mailing Address - Country:US
Mailing Address - Phone:303-416-1360
Mailing Address - Fax:303-416-1058
Practice Address - Street 1:11600 W 2ND PL
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80401-1527
Practice Address - Country:US
Practice Address - Phone:720-321-0000
Practice Address - Fax:720-321-1621
Is Sole Proprietor?:No
Enumeration Date:2010-07-10
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.00567592085R0202X
MA244625207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine