Provider Demographics
NPI:1033499553
Name:KAIRALLA, BRIAN (PA-C)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:
Last Name:KAIRALLA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3455 RINGSBY CT STE 102
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80216-4923
Mailing Address - Country:US
Mailing Address - Phone:300-500-1518
Mailing Address - Fax:
Practice Address - Street 1:3455 RINGSBY CT STE 102
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80216-4923
Practice Address - Country:US
Practice Address - Phone:300-500-1518
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-29
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0004861363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical