Healthcare Provider Details

I. General information

NPI: 1033538848
Provider Name (Legal Business Name): NICHOLAS BREITNAUER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2014
Last Update Date: 05/13/2024
Certification Date: 03/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1339 S FEDERAL BLVD
DENVER CO
80219-4235
US

IV. Provider business mailing address

1339 S FEDERAL BLVD
DENVER CO
80219-4235
US

V. Phone/Fax

Practice location:
  • Phone: 303-602-0002
  • Fax: 303-602-0050
Mailing address:
  • Phone: 303-602-0002
  • Fax: 303-602-0050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberCODR0060751
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberDR.0060751
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: