Provider Demographics
NPI:1689332421
Name:KISANG, GREG F
Entity Type:Individual
Prefix:
First Name:GREG
Middle Name:F
Last Name:KISANG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1555 S WADSWORTH BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80232-6832
Mailing Address - Country:US
Mailing Address - Phone:720-476-2617
Mailing Address - Fax:
Practice Address - Street 1:15101 E ILIFF AVE STE 140
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-4548
Practice Address - Country:US
Practice Address - Phone:720-485-4287
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-29
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator