MEDICARE: PEDIATRICS AT CHERRY CREEK,LLC

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	261QP2300X	Primary Care Clinic/Center
2	208000000X	Pediatrics Physician	32058	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194854406
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEDIATRICS AT CHERRY CREEK,LLC

Provider Business Mailing Address
First Line	:	300 S JACKSON ST STE 300
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80209-3134
Country	:	US
Telephone Number	:	303-377-9663
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 S JACKSON ST STE 300
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80209-3134
Country	:	US
Telephone Number	:	303-377-9663
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ELISABETH STAERZ
Credential	:	MD
Telephone Number	:	303-377-9663

Provider Enumeration Date	:	03/04/2007
Last Update Date	:	06/23/2021

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