Provider Demographics
NPI:1639156417
Name:FREESTONE, KRISTIN (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:
Last Name:FREESTONE
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 1:10800 E GEDDES AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80112-3895
Mailing Address - Country:US
Mailing Address - Phone:303-761-9190
Mailing Address - Fax:720-874-4462
Practice Address - Street 1:501 E HAMPDEN AVE
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-2702
Practice Address - Country:US
Practice Address - Phone:303-761-9190
Practice Address - Fax:720-874-4462
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD176502085R0202X
NE229392085R0202X
KS04-308222085R0202X
CO384522085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1639156417Medicaid
UT1639156417Medicaid
GA797692031AMedicaid
MI104686131Medicaid
IA1639156417Medicaid
WI2611900Medicaid
NM44887728Medicaid
COP00057159OtherRR MCRE MIC
CO29838533Medicaid
NE10025709000Medicaid
WY1639156417Medicaid
COP00057178OtherRR MCRE RIA
SD1639156417Medicaid
AZ814089Medicaid
OK200236560AMedicaid
NE84-059792913Medicaid
AKMD558COMedicaid
KS200418160AMedicaid
TX202791401Medicaid
NC7617654Medicaid
NEP00720360OtherRR MCR NE
UT1639156417Medicaid
IA1639156417Medicaid
AKMD558COMedicaid
COC507338Medicare PIN
KSKA3249014Medicare PIN
GA797692031AMedicaid
AZ814089Medicaid
SD1639156417Medicaid
NENA1214007Medicare PIN
COP00057159OtherRR MCRE MIC
WY1639156417Medicaid
COC507348Medicare PIN