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General NPI Number Information
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NPI Number | 1205188794
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Entity Type | Organization
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Legal Business Name | HIGHLANDS INTEGRATIVE PEDIATICS, PC
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Dates
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Enumeration Date | 10/08/2012
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Last Update Date | 10/08/2012
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Provider Practice Location Address
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Address Line | 2650 18TH ST SUITE 100
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City | DENVER
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State | CO
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Zip | 80211-3932
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Country | US
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Telephone | 720-941-8983
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Fax |
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Provider Business Mailing Address
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Address Line | 2650 18TH ST SUITE 100
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City | DENVER
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State | CO
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Zip | 80211-3932
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Country | US
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Telephone | 720-941-8983
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN OWNER
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Name | DR. BRYAN KONO
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Credential | M.D.
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Telephone | 720-941-8983
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 45399
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License Number State | CO
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