Healthcare Provider Details

I. General information

NPI: 1831948355
Provider Name (Legal Business Name): ALMADELIC MEDICAL GROUP OHA PC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2024
Last Update Date: 05/31/2024
Certification Date: 05/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1385 S COLORADO BLVD # A712
DENVER CO
80222-3304
US

IV. Provider business mailing address

1385 S COLORADO BLVD # A712
DENVER CO
80222-3304
US

V. Phone/Fax

Practice location:
  • Phone: 303-521-0533
  • Fax:
Mailing address:
  • Phone: 303-521-0533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KIRILL MERKULOV
Title or Position: CFO
Credential:
Phone: 303-521-0533