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General NPI Number Information
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NPI Number | 1578102059
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Entity Type | Organization
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Legal Business Name | ALTITUDE KIDNEY HEALTH PLLC
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Dates
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Enumeration Date | 12/31/2019
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Last Update Date | 12/31/2019
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Provider Practice Location Address
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Address Line | 350 S 400 E
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City | BOUNTIFUL
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State | UT
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Zip | 84010-4932
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Country | US
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Telephone | 720-500-3439
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Fax |
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Provider Business Mailing Address
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Address Line | 1260 S PARKER RD STE 202
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City | DENVER
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State | CO
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Zip | 80231-8068
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Country | US
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Telephone | 720-500-3439
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Fax | 920-500-3559
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Authorized Official
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Title or Position | FOUNDER OWNER
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Name | ANDREW ERIC BROOKENS
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Credential | MD
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Telephone | 720-500-3439
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number |
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License Number State |
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