Healthcare Provider Details

I. General information

NPI: 1275359952
Provider Name (Legal Business Name): PINNACLE PEDIATRICS AND INTERNAL MEDICINE PROFESSIONAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2024
Last Update Date: 11/27/2024
Certification Date: 11/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1776 CURTIS ST STE 130
DENVER CO
80202-2541
US

IV. Provider business mailing address

1776 CURTIS ST STE 130
DENVER CO
80202-2541
US

V. Phone/Fax

Practice location:
  • Phone: 720-239-7725
  • Fax: 720-239-7730
Mailing address:
  • Phone: 720-239-7725
  • Fax: 720-239-7730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: WALTER WILSON
Title or Position: OWNER
Credential:
Phone: 720-223-6177