Healthcare Provider Details

I. General information

NPI: 1952471971
Provider Name (Legal Business Name): PEAK PEDIATRICS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 07/21/2022
Certification Date: 02/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3555 LUTHERAN PKWY STE 340
WHEAT RIDGE CO
80033-6039
US

IV. Provider business mailing address

3555 LUTHERAN PKWY #340
WHEAT RIDGE CO
80033-6021
US

V. Phone/Fax

Practice location:
  • Phone: 303-996-6005
  • Fax: 303-420-8831
Mailing address:
  • Phone: 303-996-6005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier9000105583
Identifier TypeMEDICAID
Identifier StateCO
Identifier Issuer
# 2
Identifier62657763
Identifier TypeMEDICAID
Identifier StateCO
Identifier Issuer

VIII. Authorized Official

Name: MELISSA ANN HERRMANN
Title or Position: BILLING MANAGER
Credential: CMC
Phone: 303-996-6005