Healthcare Provider Details

I. General information

NPI: 1043992498
Provider Name (Legal Business Name): MILE HIGH SPORTS AND REHABILITATION MEDICINE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2023
Last Update Date: 01/23/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4545 E 9TH AVE STE 440
DENVER CO
80220-3914
US

IV. Provider business mailing address

2490 W 26TH AVE STE 10A
DENVER CO
80211-5300
US

V. Phone/Fax

Practice location:
  • Phone: 303-331-6744
  • Fax: 303-331-6839
Mailing address:
  • Phone: 303-331-6744
  • Fax: 303-331-6839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: CESAR CARRERA
Title or Position: PRACTICE MANAGER
Credential:
Phone: 303-331-6744