MEDICARE: INTERMOUNTAIN MEDICAL GROUP DENVER, 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	207RX0202X	Medical Oncology Physician
2	207RH0003X	Hematology & Oncology Physician

General Provider Information

NPI Number	:	1790642338
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTERMOUNTAIN MEDICAL GROUP DENVER, LLC

Provider Business Mailing Address
First Line	:	500 ELDORADO BLVD STE 4300
Second Line	:
City	:	BROOMFIELD
State	:	CO
Zip	:	80021-3564
Country	:	US
Telephone Number	:	303-272-0566
Fax Number	:	303-272-0390

Provider Business Practice Location Address
First Line	:	1818 N OGDEN ST STE 200
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80218-1295
Country	:	US
Telephone Number	:	303-318-3434
Fax Number	:	303-318-3431

Authorized Official
Title or Position	:	VP FINANCE
Name	:	SEAN FADDEN
Credential	:
Telephone Number	:	303-425-2410

Provider Enumeration Date	:	01/06/2026
Last Update Date	:	02/10/2026

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