Basic Information
| Provider Information | |||||||||
| NPI: | 1215469705 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PHILIP | ||||||||
| FirstName: | KEMLY | ||||||||
| MiddleName: | MARY | ||||||||
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| Credential: | MD PHD MBE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12631 E. 17TH AVE. | ||||||||
| Address2: | MSF493 AO1 RM 1201E | ||||||||
| City: | AURORA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800455389 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037247408 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 12631 E. 17TH AVE. | ||||||||
| Address2: | MSF493 AO1 RM 1201E | ||||||||
| City: | AURORA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800455389 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037247408 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2017 | ||||||||
| LastUpdateDate: | 07/01/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.