Healthcare Provider Details

I. General information

NPI: 1518287549
Provider Name (Legal Business Name): MILE HIGH ALLERGY ASTHMA & SINUS CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2010
Last Update Date: 02/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7700 W VIRGINIA AVE UNIT B
LAKEWOOD CO
80226-3144
US

IV. Provider business mailing address

7700 W VIRGINIA AVE UNIT B
LAKEWOOD CO
80226-3144
US

V. Phone/Fax

Practice location:
  • Phone: 303-238-0471
  • Fax: 303-238-6711
Mailing address:
  • Phone: 303-238-0471
  • Fax: 303-238-6711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number40997
License Number StateCO

VIII. Authorized Official

Name: DR. JAGADISH BOGGAVARAPU
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 303-238-0471