Individual
DR. LAURA C KISSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1400 E BOULDER ST STE 600, COLORADO SPRINGS, CO 80909-5533
(719) 364-6487
(719) 364-8347
Mailing address
2695 ROCKY MOUNTAIN AVE STE 150, LOVELAND, CO 80538-9071
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
200400694
NC
2086S0129X
Vascular Surgery Physician
Primary
44538
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
200400694
PHYSICIAN LICENSE
NC
01
—
44538
PHYSICIAN LICENSE
CO
01
—
805636
MEDICARE ID
—
01
—
COA109844
MEDICARE INDIVIDUAL PTAN
CO
Enumeration date
05/16/2006
Last updated
02/10/2020
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