=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255674446
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JURI BOGUNIEWICZ MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/05/2013
-----------------------------------------------------
Last Update Date | 04/25/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 69 DEERWOOD DR
-----------------------------------------------------
City | LITTLETON
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80127-2627
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-906-5709
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 69 DEERWOOD DR
-----------------------------------------------------
City | LITTLETON
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80127-2627
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-906-5709
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | DR.0062167
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2080P0208X
-----------------------------------------------------
Taxonomy Name | Pediatric Infectious Diseases Physician
-----------------------------------------------------
License Number | 62167
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------