MEDICARE: PINNACLE PEDIATRICS AND INTERNAL MEDICINE PROFESSIONAL LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207R00000X	Internal Medicine Physician
2	208000000X	Pediatrics Physician
3	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1447060868
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PINNACLE PEDIATRICS AND INTERNAL MEDICINE PROFESSIONAL LLC

Provider Business Mailing Address
First Line	:	1776 CURTIS ST STE 130
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80202-2541
Country	:	US
Telephone Number	:	720-239-7725
Fax Number	:

Provider Business Practice Location Address
First Line	:	2121 S ONEIDA ST STE 248
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80224-2551
Country	:	US
Telephone Number	:	303-504-0600
Fax Number	:	303-504-0601

Authorized Official
Title or Position	:	OWNER
Name	:	WALTER WILSON
Credential	:
Telephone Number	:	720-223-6177

Provider Enumeration Date	:	01/08/2025
Last Update Date	:	01/08/2025

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