Provider Demographics
NPI:1184750408
Name:KITTELSEN, THOMAS P (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:P
Last Name:KITTELSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4791 AMAROSA HTS APT 204
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-7929
Mailing Address - Country:US
Mailing Address - Phone:719-306-4543
Mailing Address - Fax:833-953-0009
Practice Address - Street 1:7680 GODDARD ST STE 120
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-8233
Practice Address - Country:US
Practice Address - Phone:719-306-4543
Practice Address - Fax:833-953-0009
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV87342084P0800X
COCDRH.00474332084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
F06341Medicare UPIN