Provider Demographics
NPI:1396776993
Name:KATHY FINE MCCRANIE MD PROF LLC
Entity type:Organization
Organization Name:KATHY FINE MCCRANIE MD PROF LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:FINE
Authorized Official - Last Name:MCCRANIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-777-3422
Mailing Address - Street 1:PO BOX 17794
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80217-0794
Mailing Address - Country:US
Mailing Address - Phone:800-968-6866
Mailing Address - Fax:616-532-7230
Practice Address - Street 1:1380 S SANTA FE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80223-3216
Practice Address - Country:US
Practice Address - Phone:303-777-3425
Practice Address - Fax:303-777-3425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO30645208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO49139258Medicaid
KA670691OtherBC/BS
KA670691OtherBC/BS