Healthcare Provider Details

I. General information

NPI: 1639181126
Provider Name (Legal Business Name): NINTH AVENUE INTERNAL MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 09/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 E 9TH AVE SUITE 140
DENVER CO
80220-3900
US

IV. Provider business mailing address

4500 E 9TH AVE SUITE 140
DENVER CO
80220-3900
US

V. Phone/Fax

Practice location:
  • Phone: 303-394-2152
  • Fax: 303-394-2496
Mailing address:
  • Phone: 303-394-2152
  • Fax: 303-394-2496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. DANIEL WITTEN
Title or Position: MANAGING PARTNER
Credential: MD
Phone: 303-394-2152