Provider Demographics
NPI:1679545941
Name:VAN KERCKHOVE, CATHERINE M (MD)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:M
Last Name:VAN KERCKHOVE
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 1:4 SANDY LAKE RD
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80113-4140
Mailing Address - Country:US
Mailing Address - Phone:303-777-1551
Mailing Address - Fax:
Practice Address - Street 1:125 RAMPART WAY
Practice Address - Street 2:SUITE 200
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80230-6406
Practice Address - Country:US
Practice Address - Phone:720-858-7600
Practice Address - Fax:720-858-7605
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO35006174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01350065Medicaid
COG21080Medicare UPIN
CO01350065Medicaid