Provider Demographics
NPI:1861474751
Name:KLEINERT, DORIS ANDREA (MD)
Entity Type:Individual
Prefix:DR
First Name:DORIS
Middle Name:ANDREA
Last Name:KLEINERT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:'ANDI'
Other - Middle Name:
Other - Last Name:KLEINERT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:7495 PYRITE WAY
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80108-3052
Mailing Address - Country:US
Mailing Address - Phone:303-282-5251
Mailing Address - Fax:303-688-8260
Practice Address - Street 1:4386 TRAIL BOSS DR
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-7512
Practice Address - Country:US
Practice Address - Phone:303-688-8666
Practice Address - Fax:303-688-8260
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO38172207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO86609823Medicaid
CO86609823Medicaid