Provider Demographics
NPI:1811123474
Name:KAMM, KARL AUGUST (PA-C)
Entity type:Individual
Prefix:
First Name:KARL
Middle Name:AUGUST
Last Name:KAMM
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:KARL
Other - Middle Name:AUGUST
Other - Last Name:KAMM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHYSICIAN ASSISTANT
Mailing Address - Street 1:PO BOX 529
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:CO
Mailing Address - Zip Code:81425-0529
Mailing Address - Country:US
Mailing Address - Phone:970-323-6141
Mailing Address - Fax:855-299-8071
Practice Address - Street 1:1010 S RIO GRANDE AVE
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-4831
Practice Address - Country:US
Practice Address - Phone:970-497-3333
Practice Address - Fax:855-299-7837
Is Sole Proprietor?:No
Enumeration Date:2009-06-09
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPA2009-0006363AM0700X
COPA.0003902363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO52452531Medicaid
CO342432YLKWMedicare PIN