Provider Demographics
NPI:1265886782
Name:RECHUL, KISRIA (MD)
Entity type:Individual
Prefix:DR
First Name:KISRIA
Middle Name:
Last Name:RECHUL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5040 CORPORATE PLAZA DR STE 7
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-6100
Mailing Address - Country:US
Mailing Address - Phone:719-301-6296
Mailing Address - Fax:719-434-9869
Practice Address - Street 1:3500 COMANCHE RD NE STE C
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-4546
Practice Address - Country:US
Practice Address - Phone:505-998-7200
Practice Address - Fax:505-998-7220
Is Sole Proprietor?:No
Enumeration Date:2016-04-21
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0063033207Q00000X, 2083B0002X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083B0002XAllopathic & Osteopathic PhysiciansPreventive MedicineObesity Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program