Provider Demographics
NPI:1760492599
Name:GINSBURG, KENNETH (PA)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:
Last Name:GINSBURG
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5955 LEHMAN DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-3420
Mailing Address - Country:US
Mailing Address - Phone:719-598-7151
Mailing Address - Fax:
Practice Address - Street 1:5955 LEHMAN DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-3420
Practice Address - Country:US
Practice Address - Phone:719-598-7151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO931363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO48400271Medicaid
Q13918Medicare UPIN
CO48400271Medicaid