Healthcare Provider Details

I. General information

NPI: 1982734430
Provider Name (Legal Business Name): SOUTHEAST DENVER PEDIATRICS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 S ONEIDA ST SUITE 200
DENVER CO
80224-2549
US

IV. Provider business mailing address

2121 S ONEIDA ST SUITE 200
DENVER CO
80224-2549
US

V. Phone/Fax

Practice location:
  • Phone: 303-757-6418
  • Fax: 303-757-2209
Mailing address:
  • Phone: 303-757-6418
  • Fax: 303-757-2209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DANIEL PAUL MIGA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 303-757-6418