Provider Demographics
NPI:1003866880
Name:BREKHUS, KIT K (MD)
Entity type:Individual
Prefix:DR
First Name:KIT
Middle Name:K
Last Name:BREKHUS
Suffix:
Gender:
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:PO BOX 35380
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89133-5380
Mailing Address - Country:US
Mailing Address - Phone:719-400-7470
Mailing Address - Fax:
Practice Address - Street 1:7550 W YALE AVE STE 100
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80227-3465
Practice Address - Country:US
Practice Address - Phone:303-935-4689
Practice Address - Fax:303-935-3829
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCDRH.0030901207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1309012Medicaid
CO080165388OtherRR MEDICARE
COBR31982OtherBLUE SHIELD
COBRA31982OtherBLUE SHIELD
COBR31982OtherBLUE SHIELD
COC450578Medicare PIN
COP00222536OtherRR MEDICARE