Provider Demographics
NPI:1457364630
Name:KIEFER, GAIL (MD)
Entity Type:Individual
Prefix:DR
First Name:GAIL
Middle Name:
Last Name:KIEFER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GAIL
Other - Middle Name:KIEFER
Other - Last Name:LUCKS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1277 S GAYLORD ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-1828
Mailing Address - Country:US
Mailing Address - Phone:720-941-5567
Mailing Address - Fax:720-941-4102
Practice Address - Street 1:1277 S GAYLORD ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-1828
Practice Address - Country:US
Practice Address - Phone:720-941-5567
Practice Address - Fax:720-941-4102
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2010-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036066211207L00000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO70674361Medicaid
IL036066211Medicaid
ILC48399Medicare UPIN
COCOA102717Medicare PIN
CO70674361Medicaid