Healthcare Provider Details

I. General information

NPI: 1609842277
Provider Name (Legal Business Name): MILE HIGH PRIMARY CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 12/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2230 S FRASER ST UNIT 1
AURORA CO
80014-4535
US

IV. Provider business mailing address

2230 S FRASER ST UNIT 1
AURORA CO
80014-4535
US

V. Phone/Fax

Practice location:
  • Phone: 303-341-4200
  • Fax: 303-341-4480
Mailing address:
  • Phone: 303-341-4200
  • Fax: 303-341-4480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ESTELLA M MARES
Title or Position: OFFICE MANAGER
Credential:
Phone: 303-341-4200