Provider Demographics
NPI:1194370742
Name:KIDE, MILION
Entity Type:Individual
Prefix:
First Name:MILION
Middle Name:
Last Name:KIDE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8841 E FLORIDA AVE APT A07
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80247-2824
Mailing Address - Country:US
Mailing Address - Phone:303-264-9239
Mailing Address - Fax:
Practice Address - Street 1:8841 E FLORIDA AVE APT A07
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80247-2824
Practice Address - Country:US
Practice Address - Phone:303-264-9239
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-09
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver