Individual
KIM K DERNOVSEK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1925 E ORMAN AVE, STE 115, PUEBLO, CO 81004-3537
(719) 564-4500
(719) 564-0304
Mailing address
1925 E ORMAN AVE, STE 115, PUEBLO, CO 81004-3537
(719) 564-4500
(719) 564-0304
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
26084
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01260843
—
CO
01
—
070001062
RAILROAD MEDICARE
CO
01
—
1497728786
RAILROAD MEDICARE
CO
Enumeration date
02/08/2006
Last updated
01/11/2016
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