Basic Information
| Provider Information | |||||||||
| NPI: | 1427041920 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LUBECK | ||||||||
| FirstName: | KENDALL | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 205 S GARRISON ST | ||||||||
| Address2: | |||||||||
| City: | LAKEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802262843 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7207285170 | ||||||||
| FaxNumber: | 3037301145 | ||||||||
| Practice Location | |||||||||
| Address1: | 7780 S BROADWAY | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | LITTLETON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801222648 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037989996 | ||||||||
| FaxNumber: | 3037301145 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2005 | ||||||||
| LastUpdateDate: | 12/15/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/15/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 37900 | CO | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 11936860 | 05 | CO | MEDICAID | 114679 | 01 | CO | AETNA HMO | OTHER | 7911022 | 01 | CO | AETNA PPO | OTHER | 84099770813 | 01 | CO | PACIFICARE | OTHER | 8500654003 | 01 | CO | CIGNA | OTHER |