Provider Demographics
NPI:1871680926
Name:PENGEL, KIMBERLY B (MD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:B
Last Name:PENGEL
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 1:10107 RIDGEGATE PKWY STE 310
Mailing Address - Street 2:
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-5642
Mailing Address - Country:US
Mailing Address - Phone:303-861-2663
Mailing Address - Fax:303-861-4741
Practice Address - Street 1:10107 RIDGEGATE PKWY STE 310
Practice Address - Street 2:
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-5642
Practice Address - Country:US
Practice Address - Phone:720-861-0840
Practice Address - Fax:303-861-4741
Is Sole Proprietor?:No
Enumeration Date:2006-10-09
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO38251207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO70680892Medicaid
NE1871680926Medicaid
WY1871680926Medicaid
COCF3002Medicare PIN
WY1871680926Medicaid
COCOA104419Medicare PIN