Provider Demographics
NPI:1619041886
Name:KOLRUD, BONITA L (MD)
Entity Type:Individual
Prefix:MS
First Name:BONITA
Middle Name:L
Last Name:KOLRUD
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 1:7950 KIPLING ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80005
Mailing Address - Country:US
Mailing Address - Phone:303-424-6466
Mailing Address - Fax:303-420-8944
Practice Address - Street 1:7950 KIPLING ST
Practice Address - Street 2:SUITE 201
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80005
Practice Address - Country:US
Practice Address - Phone:303-424-6466
Practice Address - Fax:303-420-8944
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCO 29390207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO012-93-901Medicaid
CO012-93-901Medicaid
CO390918Medicare PIN