Provider Demographics
NPI:1841289766
Name:KALEVIK, MARTIN C (DO)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:C
Last Name:KALEVIK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4900 S MONACO ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-3486
Mailing Address - Country:US
Mailing Address - Phone:303-534-9550
Mailing Address - Fax:720-932-7805
Practice Address - Street 1:1515 WAZEE ST
Practice Address - Street 2:SUITE D
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80202-1478
Practice Address - Country:US
Practice Address - Phone:303-534-9550
Practice Address - Fax:720-932-7805
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO32024207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO05689376Medicaid
COCO300087Medicare PIN
CO471498Medicare ID - Type Unspecified
CO05689376Medicaid
COC471498Medicare PIN
COF17904Medicare UPIN