Provider Demographics
NPI:1609883271
Name:LEVIN, KIMBERLY S (MD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:S
Last Name:LEVIN
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 1:501 AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:RIFLE
Mailing Address - State:CO
Mailing Address - Zip Code:81650-8510
Mailing Address - Country:US
Mailing Address - Phone:970-625-6496
Mailing Address - Fax:970-625-7366
Practice Address - Street 1:501 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:RIFLE
Practice Address - State:CO
Practice Address - Zip Code:81650-8510
Practice Address - Country:US
Practice Address - Phone:970-625-6496
Practice Address - Fax:970-625-7366
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO44092207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO63400022Medicaid
CVN3379Medicare PIN
COCO306132Medicare PIN
CO63400022Medicaid