Provider Demographics
NPI:1205050143
Name:ANDERSON, KIRK (MD)
Entity type:Individual
Prefix:DR
First Name:KIRK
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3545 SOUTH TAMARAC DR STE #370
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237
Mailing Address - Country:US
Mailing Address - Phone:720-488-5580
Mailing Address - Fax:303-694-1274
Practice Address - Street 1:3545 S TAMARAC DR STE 370
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80237-1432
Practice Address - Country:US
Practice Address - Phone:720-488-5580
Practice Address - Fax:303-694-1274
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO357132084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry