Healthcare Provider Details

I. General information

NPI: 1548758964
Provider Name (Legal Business Name): DENVER CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2018
Last Update Date: 04/13/2023
Certification Date: 04/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 RALEIGH ST
DENVER CO
80204
US

IV. Provider business mailing address

1360 S POTOMAC ST
AURORA CO
80012-4505
US

V. Phone/Fax

Practice location:
  • Phone: 303-433-2565
  • Fax: 303-745-6264
Mailing address:
  • Phone: 303-337-5575
  • Fax: 303-745-6264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MAURICIO LUDER WAINTRUB
Title or Position: PRESIDENT
Credential:
Phone: 303-337-5575