Provider Demographics
NPI:1972063519
Name:KAVANAGH, AMBER (DPM)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:KAVANAGH
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 HALE PKWY STE 440
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-4000
Mailing Address - Country:US
Mailing Address - Phone:303-321-4477
Mailing Address - Fax:303-321-5323
Practice Address - Street 1:4600 HALE PKWY STE 440
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-4000
Practice Address - Country:US
Practice Address - Phone:303-321-4477
Practice Address - Fax:303-321-5323
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-20
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016.005971213ES0103X
390200000X
COPOD.0000928213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program