Provider Demographics
NPI:1336481175
Name:KRESO MEDICAL LLC
Entity Type:Organization
Organization Name:KRESO MEDICAL LLC
Other - Org Name:MILE HIGH INTERNAL MEDICINE AND URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KRESO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-596-4861
Mailing Address - Street 1:165 S SYRACUSE ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80230-6981
Mailing Address - Country:US
Mailing Address - Phone:303-596-4861
Mailing Address - Fax:
Practice Address - Street 1:496 S DAYTON ST
Practice Address - Street 2:SUITE C
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80247-6929
Practice Address - Country:US
Practice Address - Phone:303-341-5280
Practice Address - Fax:303-341-7163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-20
Last Update Date:2014-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR45223261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty