Provider Demographics
NPI:1356421622
Name:DULANEY, KIMBERLY LUNDGREN (MD)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:LUNDGREN
Last Name:DULANEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:SUE
Other - Last Name:LUNDGREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6011 E WOODMEN RD
Mailing Address - Street 2:STE 105
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80923-2602
Mailing Address - Country:US
Mailing Address - Phone:719-571-8600
Mailing Address - Fax:719-884-2898
Practice Address - Street 1:6011 E WOODMEN RD
Practice Address - Street 2:STE 105
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80923-2602
Practice Address - Country:US
Practice Address - Phone:719-571-8600
Practice Address - Fax:719-884-2898
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-43142207RC0000X
CO45236207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO16223519Medicaid
COC810916Medicare PIN
CO16223519Medicaid
CO263461YLB8Medicare PIN