Healthcare Provider Details

I. General information

NPI: 1699961979
Provider Name (Legal Business Name): KIDNEY ASSOCIATES OF COLORADO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2007
Last Update Date: 04/19/2022
Certification Date: 04/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 E HARVARD AVE SUITE 565
DENVER CO
80210-5073
US

IV. Provider business mailing address

850 E HARVARD AVE SUITE 565
DENVER CO
80210-5073
US

V. Phone/Fax

Practice location:
  • Phone: 303-777-3333
  • Fax: 303-733-4441
Mailing address:
  • Phone: 303-777-3333
  • Fax: 303-733-4441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number23822
License Number StateCO

VIII. Authorized Official

Name: AILEEN M MARQUEZ
Title or Position: CREDENTIALING
Credential:
Phone: 303-908-4712