Organization
CONIFER PEDIATRICS
Active
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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