Healthcare Provider Details

I. General information

NPI: 1164574562
Provider Name (Legal Business Name): WHEAT RIDGE FAMILY PHYSICIANS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 09/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 W 38TH AVE SUITE 220
DENVER CO
80212
US

IV. Provider business mailing address

4500 W 38TH AVE SUITE 220
DENVER CO
80212
US

V. Phone/Fax

Practice location:
  • Phone: 303-420-1297
  • Fax: 303-420-2953
Mailing address:
  • Phone: 303-420-1297
  • Fax: 303-420-2953

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: WENDY GARDUNO
Title or Position: OFFICE MANAGER
Credential:
Phone: 303-420-1297