Provider Demographics
NPI:1700825015
Name:BOGUSH, KIMBER F (MD)
Entity Type:Individual
Prefix:DR
First Name:KIMBER
Middle Name:F
Last Name:BOGUSH
Suffix:
Gender:M
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:PO BOX 110429
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80042-0429
Mailing Address - Country:US
Mailing Address - Phone:303-493-7000
Mailing Address - Fax:
Practice Address - Street 1:12605 E 16TH AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045
Practice Address - Country:US
Practice Address - Phone:303-493-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0058622207P00000X
GA057432207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA328790801DMedicaid
SC328790801FMedicaid
GA328790801BMedicaid
GA328790801AMedicaid
SCG57432Medicaid
GA10058538OtherAMERIGROUP
GA328790801Medicaid
GA328790801CMedicaid
GA328790801Medicaid
GA10058538OtherAMERIGROUP
GA328790801BMedicaid
GA328790801DMedicaid
SCG57432Medicaid
GA93BFCCVMedicare PIN