Provider Demographics
NPI:1952583585
Name:KEVIN J MOLK, MD, PC
Entity Type:Organization
Organization Name:KEVIN J MOLK, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NINA
Authorized Official - Middle Name:KAREN
Authorized Official - Last Name:MOLK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-617-0540
Mailing Address - Street 1:17736 E JAMISON AVE
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80016-1815
Mailing Address - Country:US
Mailing Address - Phone:303-617-0540
Mailing Address - Fax:303-699-4953
Practice Address - Street 1:9397 CROWN CREST BLVD STE 420
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80138-8789
Practice Address - Country:US
Practice Address - Phone:303-770-0500
Practice Address - Fax:303-220-5053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-05
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAM7502063207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COD23844Medicare UPIN
COCB4708Medicare PIN