Provider Demographics
NPI:1740712975
Name:MONAHAN, KATHLEEN (DO)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:MONAHAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:7951 E MAPLEWOOD AVE STE 350
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-4758
Mailing Address - Country:US
Mailing Address - Phone:303-930-7803
Mailing Address - Fax:303-930-5503
Practice Address - Street 1:4715 ARAPAHOE AVE
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-1385
Practice Address - Country:US
Practice Address - Phone:303-385-2000
Practice Address - Fax:033-267-4419
Is Sole Proprietor?:No
Enumeration Date:2017-03-28
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CODR.0072742207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1740712975Medicaid