MEDICARE: ALPINE MEDICAL GROUP COLORADO PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1053121723
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALPINE MEDICAL GROUP COLORADO PLLC

Provider Business Mailing Address
First Line	:	999 17TH ST STE 500
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80202-2728
Country	:	US
Telephone Number	:	720-728-5170
Fax Number	:	720-866-9967

Provider Business Practice Location Address
First Line	:	4500 W 38TH AVE STE 220
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80212-2005
Country	:	US
Telephone Number	:	303-420-1297
Fax Number	:	303-420-2953

Authorized Official
Title or Position	:	SUPERVISOR OF CREDENTIALING
Name	:	KERRY DOYLE
Credential	:
Telephone Number	:	720-728-5170

Provider Enumeration Date	:	01/13/2025
Last Update Date	:	01/13/2025

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