Basic Information
| Provider Information | |||||||||
| NPI: | 1083652309 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PAGANO | ||||||||
| FirstName: | KARI | ||||||||
| MiddleName: | FREEMAN | ||||||||
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| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | FILE 56765 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900746765 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6024063860 | ||||||||
| FaxNumber: | 6024066132 | ||||||||
| Practice Location | |||||||||
| Address1: | 2803 ROSLYN ST | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802382624 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034036300 | ||||||||
| FaxNumber: | 3034066315 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2006 | ||||||||
| LastUpdateDate: | 05/11/2018 | ||||||||
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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 | 207Q00000X | 45332 | AZ | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 55589 | CO | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 652217 | 05 | AZ | MEDICAID |