Provider Demographics
NPI:1740228675
Name:BUSS, KYLE W (PA-C)
Entity Type:Individual
Prefix:MR
First Name:KYLE
Middle Name:W
Last Name:BUSS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1757 RACE ST UNIT 1
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-1113
Mailing Address - Country:US
Mailing Address - Phone:303-929-7303
Mailing Address - Fax:
Practice Address - Street 1:400 S COLORADO BLVD STE 530
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80246-1255
Practice Address - Country:US
Practice Address - Phone:720-571-4738
Practice Address - Fax:720-643-5903
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1585363AM0700X
WAPA60795056363AM0700X
COPA.0001585363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1740228675Medicaid
CO21729867Medicaid
WAG8976750OtherPECOS
COCO301525Medicare PIN