Healthcare Provider Details

I. General information

NPI: 1275186470
Provider Name (Legal Business Name): PEDIATRICS AT CHERRY CREEK,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2019
Last Update Date: 06/21/2021
Certification Date: 06/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 QUEBEC ST STE 3900
DENVER CO
80207-2344
US

IV. Provider business mailing address

300 S JACKSON ST STE 300
DENVER CO
80209-3134
US

V. Phone/Fax

Practice location:
  • Phone: 303-377-9663
  • Fax:
Mailing address:
  • Phone: 303-377-9663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: ELISABETH STAERZ
Title or Position: OWNER
Credential: MD
Phone: 303-377-9663