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Organization
BOULDER ENDOCRINOLOGY PHYSICIANS
Active
Organization
BOULDER ENDOCRINOLOGY PHYSICIANS
Active
Other names
Boulder Endocrinology PLLC
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY A. MANDAGERE (M.D.)
(303) 586-5200
Entity
Organization
Contact information
Practice address
892 W SOUTH BOULDER RD, LOUISVILLE, CO 80027-2453
(303) 586-5200
(303) 586-5201
Mailing address
892 W SOUTH BOULDER RD, LOUISVILLE, CO 80027-2453
(303) 586-5200
(303) 586-5201
Taxonomy
Speciality
Code
Description
License number
State
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
45001
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
81287895
—
CO
Enumeration date
10/23/2008
Last updated
07/21/2010
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