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General NPI Number Information
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NPI Number | 1063423283
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Entity Type | Organization
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Legal Business Name | KAVANAH
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Dates
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Enumeration Date | 08/11/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1660 S ALBION ST SUITE 309
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City | DENVER
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State | CO
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Zip | 80222-4008
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Country | US
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Telephone | 303-355-7783
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Fax | 303-355-7784
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Provider Business Mailing Address
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Address Line | KAVANAH C/O NON-DOMESTIC 820 S MONACO PKWY, #293
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City | DENVER
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State | CO
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Zip | 80224
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Country | US
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Telephone | 303-355-7783
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Fax | 303-355-7784
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Authorized Official
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Title or Position | OVERSEER
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Name | DR. BARRY WAYNE FRIEDER
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Credential | OVS MD
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Telephone | 303-355-7783
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 29005
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License Number State | CO
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