Provider Demographics
NPI:1689671539
Name:BACHUS, KEVIN E (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:E
Last Name:BACHUS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1080 E ELIZABETH ST
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-3953
Mailing Address - Country:US
Mailing Address - Phone:970-493-6353
Mailing Address - Fax:970-493-6366
Practice Address - Street 1:1080 E ELIZABETH ST
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-3953
Practice Address - Country:US
Practice Address - Phone:970-493-6353
Practice Address - Fax:970-493-6366
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO27514207VG0400X, 207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01275148Medicaid
CO27514OtherSTATE LICENSE
COC82661Medicare UPIN