Provider Demographics
NPI:1821344664
Name:CHMURA, KATHRYN (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:
Last Name:CHMURA
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 1:6801 W 20TH ST
Mailing Address - Street 2:SUITE #201
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-9637
Mailing Address - Country:US
Mailing Address - Phone:970-350-5828
Mailing Address - Fax:970-378-4210
Practice Address - Street 1:6801 W 20TH ST
Practice Address - Street 2:SUITE #201
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-9637
Practice Address - Country:US
Practice Address - Phone:970-350-5828
Practice Address - Fax:970-378-4210
Is Sole Proprietor?:No
Enumeration Date:2012-07-31
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0052529208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO25577735Medicaid