Basic Information
| Provider Information | |||||||||
| NPI: | 1790085892 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HARVARD AVENUE INTERNAL MEDICINE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 850 E HARVARD AVE | ||||||||
| Address2: | SUITE 455 | ||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802105073 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037222724 | ||||||||
| FaxNumber: | 3037223121 | ||||||||
| Practice Location | |||||||||
| Address1: | 850 E HARVARD AVE | ||||||||
| Address2: | SUITE 455 | ||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802105073 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037222724 | ||||||||
| FaxNumber: | 3037223121 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2010 | ||||||||
| LastUpdateDate: | 09/07/2011 | ||||||||
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| AuthorizedOfficialLastName: | HO | ||||||||
| AuthorizedOfficialFirstName: | EDWARD | ||||||||
| AuthorizedOfficialMiddleName: | JAMES | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3037222724 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.