Provider Demographics
NPI:1780143925
Name:KLOBERDANZ, KATHERINE R (DPM)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:R
Last Name:KLOBERDANZ
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8151 SOUTHPARK LN UNIT 250
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80120-4534
Mailing Address - Country:US
Mailing Address - Phone:720-662-7184
Mailing Address - Fax:720-662-7616
Practice Address - Street 1:8151 SOUTHPARK LN UNIT 250
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-4534
Practice Address - Country:US
Practice Address - Phone:720-662-7184
Practice Address - Fax:720-662-7616
Is Sole Proprietor?:No
Enumeration Date:2019-03-18
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5951001219213E00000X
390200000X
COPOD.0000894213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program