Provider Demographics
NPI:1457557191
Name:POLOVITZ, KATHRYN ANN (MD)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:ANN
Last Name:POLOVITZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9235 CROWN CREST BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80138-8880
Mailing Address - Country:US
Mailing Address - Phone:303-840-5051
Mailing Address - Fax:
Practice Address - Street 1:9235 CROWN CREST BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80138-8880
Practice Address - Country:US
Practice Address - Phone:303-840-5051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-21
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2342207R00000X
PAMD4827972084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology