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General NPI Number Information
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NPI Number | 1710065446
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Entity Type | Organization
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Legal Business Name | ADVANCED EAR, NOSE & THROAT, PC
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 08/01/2014
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Provider Practice Location Address
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Address Line | 7400 E CRESTLINE CIR SUITE 100
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City | GREENWOOD VILLAGE
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State | CO
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Zip | 80111-3656
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Country | US
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Telephone | 303-792-3242
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Fax | 303-792-9403
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Provider Business Mailing Address
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Address Line | 7400 E CRESTLINE CIR SUITE 100
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City | GREENWOOD VILLAGE
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State | CO
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Zip | 80111-3656
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Country | US
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Telephone | 303-792-3242
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Fax | 303-792-9403
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL R MENACHOF
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Credential | MD
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Telephone | 303-792-3242
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 31645
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License Number State | CO
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