Provider Demographics
NPI:1295807394
Name:KANIA, ADRIENNE MARIE (DO)
Entity type:Individual
Prefix:MS
First Name:ADRIENNE
Middle Name:MARIE
Last Name:KANIA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1430 S 21ST STREET
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80904-4225
Mailing Address - Country:US
Mailing Address - Phone:719-633-1817
Mailing Address - Fax:719-632-3940
Practice Address - Street 1:1430 S 21ST STREET
Practice Address - Street 2:SUITE 100
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80904-4225
Practice Address - Country:US
Practice Address - Phone:719-633-1817
Practice Address - Fax:719-632-3940
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO31196207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01311968Medicaid
CO01311968Medicaid
F57300Medicare UPIN