Provider Demographics
NPI:1679540199
Name:HENNING, KIPP (MD)
Entity type:Individual
Prefix:DR
First Name:KIPP
Middle Name:
Last Name:HENNING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1633 MEDICAL CENTER POINT
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-1906
Mailing Address - Country:US
Mailing Address - Phone:719-475-7700
Mailing Address - Fax:719-471-8841
Practice Address - Street 1:1633 MEDICAL CENTER POINT
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-1906
Practice Address - Country:US
Practice Address - Phone:719-475-7700
Practice Address - Fax:719-471-8841
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO463213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01004639Medicaid
U35076Medicare UPIN
504028Medicare ID - Type Unspecified