Provider Demographics
NPI:1811099617
Name:LACHANCE, KRISTEN A (MD)
Entity type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:A
Last Name:LACHANCE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1633 MEDICAL CENTER POINT
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-1604
Mailing Address - Country:US
Mailing Address - Phone:719-667-4139
Mailing Address - Fax:719-473-8843
Practice Address - Street 1:1633 MEDICAL CENTER POINT
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-1604
Practice Address - Country:US
Practice Address - Phone:719-667-4139
Practice Address - Fax:719-473-8843
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD56272085R0202X
COLT-09382085R0202X
CT0438412085R0202X
CAA633602085R0202X
CO429522085R0202X
NY2367322085R0202X
NJ25MA080328002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO69728259Medicaid
COCO307001Medicare PIN
COH62979Medicare UPIN