Individual
MARK DAVID MENICH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3950 BROADWAY ST, BOULDER VALLEY ASTHMA AND ALLERGY CLINICS, BOULDER, CO 80304-1104
(303) 444-5995
(303) 443-5030
Mailing address
3950 BROADWAY ST, BOULDER VALLEY ASTHMA AND ALLERGY CLINICS, BOULDER, CO 80304-1104
(303) 444-5995
(303) 443-5030
Taxonomy
Speciality
Code
Description
License number
State
207KA0200X
Allergy Physician
Primary
46383
CO
207R00000X
Internal Medicine Physician
46383
CO
207RA0201X
Allergy & Immunology (Internal Medicine) Physician
MD044657E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
14209764
—
CO
Enumeration date
06/23/2006
Last updated
12/30/2015
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