Provider Demographics
NPI:1912083296
Name:KASUNIC, LOUIS BAIRD (DO)
Entity Type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:BAIRD
Last Name:KASUNIC
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:755 S PERRY ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-1901
Mailing Address - Country:US
Mailing Address - Phone:303-688-8989
Mailing Address - Fax:303-688-3482
Practice Address - Street 1:755 S PERRY ST
Practice Address - Street 2:SUITE 100
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-1901
Practice Address - Country:US
Practice Address - Phone:303-688-8989
Practice Address - Fax:303-688-3482
Is Sole Proprietor?:No
Enumeration Date:2006-10-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO28038207Q00000X
OH34.003912207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01280387Medicaid
CO01280387Medicaid
841512222OtherTIN
CO370418Medicare ID - Type Unspecified