Healthcare Provider Details

I. General information

NPI: 1013384866
Provider Name (Legal Business Name): KLARISANA PHYSICIAN SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2015
Last Update Date: 03/26/2025
Certification Date: 03/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1240 S PARKER RD STE 100
DENVER CO
80231-2177
US

IV. Provider business mailing address

8670 WOLFF CT # 270
WESTMINSTER CO
80031-6956
US

V. Phone/Fax

Practice location:
  • Phone: --
  • Fax:
Mailing address:
  • Phone: 844-455-2747
  • Fax: 800-247-9785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberP8449
License Number StateTX

VIII. Authorized Official

Name: DR. CARL JOHN BONNETT
Title or Position: MANAGING MEMBER
Credential: M.D.
Phone: 303-945-6054