Provider Demographics
NPI:1265579510
Name:SUDDARTH, KATHLEEN HEIST (MD)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:HEIST
Last Name:SUDDARTH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KATHLEEN
Other - Middle Name:ANNE
Other - Last Name:HEIST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1635 AURORA CT
Mailing Address - Street 2:F-729
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80045
Mailing Address - Country:US
Mailing Address - Phone:720-848-2300
Mailing Address - Fax:720-848-2360
Practice Address - Street 1:1635 AURORA COURT
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045
Practice Address - Country:US
Practice Address - Phone:720-848-2300
Practice Address - Fax:720-848-2360
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO47380207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO29179556Medicaid
CO29179556Medicaid
COCOA102376Medicare PIN