Provider Demographics
NPI:1750673190
Name:D'AMICO, KELLY CHRISTINE (MD)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:CHRISTINE
Last Name:D'AMICO
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 1:10800 E GEDDES AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80112-3895
Mailing Address - Country:US
Mailing Address - Phone:303-761-9190
Mailing Address - Fax:720-874-4462
Practice Address - Street 1:10800 E GEDDES AVE STE 300
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80112-3895
Practice Address - Country:US
Practice Address - Phone:303-761-9190
Practice Address - Fax:720-874-4462
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-04
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-396622085R0202X
RIMD144852085R0202X
GA754392085R0202X
NE297872085R0202X
HIMD189822085R0202X
CO579202085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO09135090Medicaid
CO558563ZLJ3OtherMEDICARE PIN
CO558563ZNTBOtherMEDICARE PIN
CO558563YQ33OtherMEDICARE PIN
CO558563YQPGOtherMEDICARE PIN
NENA1215110OtherMEDICARE PIN
NENA2517087OtherMEDICARE PIN
CO558563YQN9OtherMEDICARE PIN
KS111257096OtherMEDICARE PIN
KSKA3249087OtherMEDICARE PIN
NENA1214109OtherMEDICARE PIN
NENA2517087Medicare PIN
NENA2517087OtherMEDICARE PIN
CO558563ZNTBOtherMEDICARE PIN
NENA1214109OtherMEDICARE PIN
CO558563YQPGOtherMEDICARE PIN
CO558563ZLJ3Medicare PIN
KSKA3249087OtherMEDICARE PIN
CO558563YQ33OtherMEDICARE PIN
CO558563YQ33Medicare PIN