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NPI Code Detail

MEDICARE: MILE HIGH PSYCHIATRY LLC

MEDICARE: MILE HIGH PSYCHIATRY LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP0808XPsychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number : 1013655737
Entity Type Code : Organization
Provider Name (Legal Business Name) : MILE HIGH PSYCHIATRY LLC
Provider Business Mailing Address
First Line : 15355 E COLFAX AVE UNIT 111717
Second Line :
City : AURORA
State : CO
Zip : 80042-1975
Country : US
Telephone Number : 720-507-4779
Fax Number : 720-367-5067
Provider Business Practice Location Address
First Line : 4500 PARK GRANADA STE 202
Second Line :
City : CALABASAS
State : CA
Zip : 91302-1666
Country : US
Telephone Number : 720-507-4779
Fax Number : 720-367-5067
Authorized Official
Title or Position : CEO
Name : MICHAEL K CHISM II
Credential : PMHNP-BC
Telephone Number : 720-507-4779
Provider Enumeration Date : 05/23/2022
Last Update Date : 05/23/2022

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Directions to “MILE HIGH PSYCHIATRY LLC ” Practice Location

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