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General NPI Number Information
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NPI Number | 1982932299
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Entity Type | Organization
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Legal Business Name | DENVER COSMETIC SURGERY, PLLC
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Dates
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Enumeration Date | 11/24/2009
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Last Update Date | 11/24/2009
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Provider Practice Location Address
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Address Line | 9777 S. YOSEMITE ST SUITE 200
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City | LONE TREE
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State | CO
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Zip | 80124-3191
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Country | US
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Telephone | 303-803-1000
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Fax | 720-475-8472
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Provider Business Mailing Address
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Address Line | 5096 TEN MILE PL
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City | CASTLE ROCK
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State | CO
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Zip | 80108-8837
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Country | US
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Telephone | 720-375-0352
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Fax | 720-475-8472
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Authorized Official
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Title or Position | MEMBER MANAGER
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Name | DR. EDMON KHOURY
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Credential | M.D.
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Telephone | 303-803-1000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | DR-48333
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License Number State | CO
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