Basic Information
| Provider Information | |||||||||
| NPI: | 1891082491 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BANGIYEV | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | NIKOLAY | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2055 N HIGH ST STE 110 | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802055504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3033019019 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2055 N HIGH ST STE 110 | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802055504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3033019019 | ||||||||
| FaxNumber: | 3038616254 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2011 | ||||||||
| LastUpdateDate: | 02/26/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207YS0123X | 5101019122 | MI | N | Allopathic & Osteopathic Physicians | Otolaryngology | Facial Plastic Surgery | 207YP0228X | 58725 | CO | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Otolaryngology | Pediatric Otolaryngology |
No ID Information.