Provider Demographics
NPI:1750436622
Name:DAHAB, KATHERINE S (MD)
Entity type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:S
Last Name:DAHAB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KATHERINE
Other - Middle Name:EMMA
Other - Last Name:STABENOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4500 E. 9TH AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220
Mailing Address - Country:US
Mailing Address - Phone:303-493-7000
Mailing Address - Fax:
Practice Address - Street 1:4500 E. 9TH AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220
Practice Address - Country:US
Practice Address - Phone:720-941-1778
Practice Address - Fax:720-941-1783
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO501282080S0010X, 208000000X, 2080S0010X
CODR.0050128207XX0005X
WI54547-0202080S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No2080S0010XAllopathic & Osteopathic PhysiciansPediatricsSports Medicine
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO37925768Medicaid
MD417392900Medicaid
COCOAAA1098Medicare PIN
CO37925768Medicaid