Individual
KIM ANN FREDERICKSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
9191 GRANT ST., THORNTON, CO 80229-8812
(303) 450-4482
(303) 306-7753
Mailing address
PO BOX 173862, DENVER, CO 80217-3862
(303) 306-7783
(303) 306-7753
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
DR.0046734
CO
207P00000X
Emergency Medicine Physician
T4918
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33455074
—
CO
01
—
P00632056
RAILROAD MEDICARE
CO
Enumeration date
02/21/2007
Last updated
06/25/2015
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