Basic Information
| Provider Information | |||||||||
| NPI: | 1437131547 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LARSEN | ||||||||
| FirstName: | KARL | ||||||||
| MiddleName: | MARTIN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2446 RESEARCH PKWY | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809201087 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7196231050 | ||||||||
| FaxNumber: | 7196231052 | ||||||||
| Practice Location | |||||||||
| Address1: | 2446 RESEARCH PKWY | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809201087 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7196231050 | ||||||||
| FaxNumber: | 7196231052 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/15/2005 | ||||||||
| LastUpdateDate: | 11/03/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 41401 | KY | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XS0106X | 41401 | KY | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Hand Surgery | 207X00000X | 43404 | CO | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XS0106X | 43404 | CO | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Hand Surgery |
ID Information
| ID | Type | State | Issuer | Description | 68003561 | 05 | CO | MEDICAID | 7100048560 | 05 | KY | MEDICAID |