Basic Information
| Provider Information | |||||||||
| NPI: | 1306100888 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BORDEN | ||||||||
| FirstName: | KELLY | ||||||||
| MiddleName: | CHRISTINE | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10700 E GEDDES AVE STE 200 | ||||||||
| Address2: | |||||||||
| City: | ENGLEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801123861 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037619190 | ||||||||
| FaxNumber: | 7208744462 | ||||||||
| Practice Location | |||||||||
| Address1: | 10700 E GEDDES AVE STE 200 | ||||||||
| Address2: | |||||||||
| City: | ENGLEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801123861 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037619190 | ||||||||
| FaxNumber: | 7208744462 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2012 | ||||||||
| LastUpdateDate: | 11/13/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 2085R0202X | 58573 | CO | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | NA1214131 | 01 | NE | MEDICARE | OTHER | 10026277700 | 05 | NE | MEDICAID | 584657ZNTB | 01 | CO | MEDICARE | OTHER | 9000148903 | 05 | CO | MEDICAID | 584657YQPG | 01 | CO | MEDICARE | OTHER | 584657ZLJ3 | 01 | CO | MEDICARE | OTHER | 84089712600 | 05 | NE | MEDICAID | 10025709000 | 05 | NE | MEDICAID | 10026277400 | 05 | NE | MEDICAID | 10026277500 | 05 | NE | MEDICAID | 10026277600 | 05 | NE | MEDICAID | 10026277800 | 05 | NE | MEDICAID | 584657YQ33 | 01 | CO | MEDICARE | OTHER | 84059792913 | 05 | NE | MEDICAID | 10026277300 | 05 | NE | MEDICAID | 584657YQN9 | 01 | CO | MEDICARE | OTHER | NA1215132 | 01 | NE | MEDICARE | OTHER | NA2517104 | 01 | NE | MEDICARE | OTHER |