Provider Demographics
NPI:1790857340
Name:GREENE, KELLY E (MD)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:E
Last Name:GREENE
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 1:15 W DRY CREEK CIR
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80120-4427
Mailing Address - Country:US
Mailing Address - Phone:303-919-3869
Mailing Address - Fax:
Practice Address - Street 1:15 W DRY CREEK CIR
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-4427
Practice Address - Country:US
Practice Address - Phone:303-952-1100
Practice Address - Fax:720-287-3183
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO35513207R00000X, 207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO91034752Medicaid
COC807166Medicare PIN
COE53791Medicare UPIN