Provider Demographics
NPI:1558592287
Name:PERIYALWAR, KAVITHA (MD,)
Entity type:Individual
Prefix:DR
First Name:KAVITHA
Middle Name:
Last Name:PERIYALWAR
Suffix:
Gender:
Credentials:MD,
Other - Prefix:DR
Other - First Name:KAVITHA
Other - Middle Name:
Other - Last Name:SRIGHANTHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:10350 E DAKOTA AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80247-1314
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10350 E DAKOTA AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80247-1314
Practice Address - Country:US
Practice Address - Phone:303-338-4545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-29
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0060937207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO029652OtherKAISER COMMERCIAL NUMBER
CO9000173020Medicaid
OH0065448Medicaid