MEDICARE: MILE HIGH ALLERGY ASTHMA & SINUS CENTER, 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
1	207K00000X	Allergy & Immunology Physician	40997	CO

General Provider Information

NPI Number	:	1518287549
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MILE HIGH ALLERGY ASTHMA & SINUS CENTER, LLC

Provider Business Mailing Address
First Line	:	7700 W VIRGINIA AVE
Second Line	:	UNIT B
City	:	LAKEWOOD
State	:	CO
Zip	:	80226-3144
Country	:	US
Telephone Number	:	303-238-0471
Fax Number	:	303-238-6711

Provider Business Practice Location Address
First Line	:	7700 W VIRGINIA AVE
Second Line	:	UNIT B
City	:	LAKEWOOD
State	:	CO
Zip	:	80226-3144
Country	:	US
Telephone Number	:	303-238-0471
Fax Number	:	303-238-6711

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. JAGADISH BOGGAVARAPU
Credential	:	M.D.
Telephone Number	:	303-238-0471

Provider Enumeration Date	:	06/01/2010
Last Update Date	:	02/17/2011

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