Basic Information
| Provider Information | |||||||||
| NPI: | 1487635173 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KELLY | ||||||||
| FirstName: | CYNTHIA | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4900 S MONACO ST | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802373486 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3038370072 | ||||||||
| FaxNumber: | 3038370075 | ||||||||
| Practice Location | |||||||||
| Address1: | 1601 E 19TH AVE | ||||||||
| Address2: | SUITE 3300 | ||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802181216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3038370072 | ||||||||
| FaxNumber: | 3038370075 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2005 | ||||||||
| LastUpdateDate: | 02/09/2022 | ||||||||
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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 | 207X00000X | 34692 | CO | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 115017100 | 05 | WY | MEDICAID | 1245556091 | 05 | NE | MEDICAID | 28887280 | 05 | NM | MEDICAID | 01346923 | 05 | CO | MEDICAID |