Provider Demographics
NPI:1649284811
Name:CARNAHAN, JILL C (MD)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:C
Last Name:CARNAHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:
Other - Last Name:HODEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:400 S MCCASLIN BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-9731
Mailing Address - Country:US
Mailing Address - Phone:303-993-7910
Mailing Address - Fax:303-993-4674
Practice Address - Street 1:400 S MCCASLIN BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-9731
Practice Address - Country:US
Practice Address - Phone:303-993-7910
Practice Address - Fax:303-993-4674
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2015-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036114041207Q00000X
CO49431207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine