Basic Information
Provider Information | |||||||||
NPI: | 1639156417 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | FREESTONE | ||||||||
FirstName: | KRISTIN | ||||||||
MiddleName: |   | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 10700 E GEDDES AVE | ||||||||
Address2: | NO 200 | ||||||||
City: | ENGLEWOOD | ||||||||
State: | CO | ||||||||
PostalCode: | 801123800 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3037619190 | ||||||||
FaxNumber: | 7208744462 | ||||||||
Practice Location | |||||||||
Address1: | 501 E HAMPDEN AVE | ||||||||
Address2: |   | ||||||||
City: | ENGLEWOOD | ||||||||
State: | CO | ||||||||
PostalCode: | 801132702 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3037619190 | ||||||||
FaxNumber: | 7208744462 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/22/2005 | ||||||||
LastUpdateDate: | 04/07/2017 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 38452 | CO | Y |   | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | 22939 | NE | N |   | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | 04-30822 | KS | N |   | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | MD17650 | HI | N |   | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
ID | Type | State | Issuer | Description | 1639156417 | 05 | IA |   | MEDICAID | 44887728 | 05 | NM |   | MEDICAID | 200236560A | 05 | OK |   | MEDICAID | P00057159 | 01 | CO | RR MCRE MIC | OTHER | 1639156417 | 05 | SD |   | MEDICAID | 202791401 | 05 | TX |   | MEDICAID | 7617654 | 05 | NC |   | MEDICAID | 10025709000 | 05 | NE |   | MEDICAID | 104686131 | 05 | MI |   | MEDICAID | 1639156417 | 05 | WY |   | MEDICAID | MD558CO | 05 | AK |   | MEDICAID | 29838533 | 05 | CO |   | MEDICAID | 797692031A | 05 | GA |   | MEDICAID | 84-059792913 | 05 | NE |   | MEDICAID | P00057178 | 01 | CO | RR MCRE RIA | OTHER | 2611900 | 05 | WI |   | MEDICAID | P00720360 | 01 | NE | RR MCR NE | OTHER | 200418160A | 05 | KS |   | MEDICAID | 1639156417 | 05 | UT |   | MEDICAID | 1639156417 | 05 | ID |   | MEDICAID | 814089 | 05 | AZ |   | MEDICAID |