Organization
CONIFER PEDIATRICS
Active
Parent organization
EVERGREEN PEDIATRICS LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
EVERGREEN PEDIATRICS LLC
Authorized official
KENNETH JOHN KUTALEK MD (OWNER/PHYSICIAN)
(303) 674-6671
Entity
Organization
Contact information
Practice address
26719 PLEASANT PARK RD UNIT 120, CONIFER, CO 80433-7753
(303) 838-7337
(303) 816-6387
Mailing address
30960 STAGECOACH BLVD # W-120, EVERGREEN, CO 80439-7902
(303) 674-6671
(303) 674-0031
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
26133
CO
Other
Enumeration date
04/19/2018
Last updated
04/19/2018
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