Diane Lucy Kallgren, M.D.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

33197 Issued in CO

Practice address

3434 47TH St
#200
Boulder, CO 80301-1880

Phone

(303) 444-8100

Fax

(303) 444-8113

NPI assigned

Sep 7, 2005

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Kallgren Dermatology

  • Dermatology Physician
  • Boulder, CO
  • NPI 1275953689
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1126051200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1188172800000",
    "number": "1144214016",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3434 47TH ST",
            "address_2": "#200",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803011880",
            "telephone_number": "303-444-8100",
            "fax_number": "303-444-8113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3434 47TH ST",
            "address_2": "#200",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803011880",
            "telephone_number": "303-444-8100",
            "fax_number": "303-444-8113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KALLGREN",
        "first_name": "DIANE",
        "middle_name": "LUCY",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-09-07",
        "last_updated": "2007-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "CO",
            "license": "33197",
            "primary": false
        },
        {
            "code": "207ND0900X",
            "taxonomy_group": "",
            "desc": "Dermatology, Dermatopathology",
            "state": "CO",
            "license": "33197",
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "CO",
            "license": "33197",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeremy Kalan, LPCC, CPCC
• Kelly Kale, RBT
• Lisa Kalfas, DDS
• Kallgren Dermatology
• Kallgren Dermatology Clinic, P.C.
• Nataraja Kallio, MA, LPCC
• Vinaya K Kamath, M.D.
• Robert James Kammer Jr., DDS
• Jill Kamon, M.D.
• Anne M Kane, RN

• Dermatology Physician in Boulder, CO
• Providers in Boulder, CO by specialty
• Dermatology Physician in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.