Organization
BOULDER VALLEY ASTHMA & ALLERGY CLINICS, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK DAVID MENICH MD (PHYSICIAN)
(303) 234-1067
Entity
Organization
Contact information
Practice address
3950 BROADWAY ST, BOULDER, CO 80304-1104
(303) 234-1067
(303) 232-2967
Mailing address
1746 COLE BLVD STE 320, LAKEWOOD, CO 80401-3208
(303) 234-1067
(303) 232-2967
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04006102
—
CO
Enumeration date
05/01/2007
Last updated
06/10/2020
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