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General NPI Number Information
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NPI Number | 1649802935
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Entity Type | Organization
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Legal Business Name | MILE HIGH METABOLIC LLC
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Dates
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Enumeration Date | 02/05/2020
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Last Update Date | 02/05/2020
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Provider Practice Location Address
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Address Line | 6200 S SYRACUSE WAY STE 260
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City | GREENWOOD VILLAGE
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State | CO
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Zip | 80111-4739
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Country | US
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Telephone | 303-542-6899
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Fax |
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Provider Business Mailing Address
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Address Line | 4942 W UNION AVE
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City | DENVER
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State | CO
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Zip | 80236-3319
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Country | US
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Telephone | 239-404-6530
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Fax |
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Authorized Official
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Title or Position | OWNER / CMO
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Name | DR. SAMANTHA ANN DELIERE
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Credential | MD
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Telephone | 239-404-6530
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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