Provider Demographics
NPI:1639396054
Name:COUSINS, RENEE A (MD)
Entity Type:Individual
Prefix:DR
First Name:RENEE
Middle Name:A
Last Name:COUSINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:RENEE
Other - Middle Name:COUSINS
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:751 S ONEIDA ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80224-1572
Mailing Address - Country:US
Mailing Address - Phone:303-329-0784
Mailing Address - Fax:303-316-7998
Practice Address - Street 1:10350 E DAKOTA AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80247-1314
Practice Address - Country:US
Practice Address - Phone:303-743-5855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO25768208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01257682Medicaid
003458OtherKAISER-COMMERCIAL NUMBER
003458OtherKAISER-COMMERCIAL NUMBER
COCK10152Medicare PIN
COE97586Medicare UPIN