Provider Demographics
NPI:1487866786
Name:BUENAVENTURA, MICHAELA (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAELA
Middle Name:
Last Name:BUENAVENTURA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MICHAELA
Other - Middle Name:
Other - Last Name:KOONTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 110429
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80042-0429
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13123 E 16TH AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-7106
Practice Address - Country:US
Practice Address - Phone:720-777-1234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57.0044702080P0205X
OH350899502080P0205X
CO00541162080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH421800OtherWELLCARE
OH9199095OtherAETNA
OH000000538734OtherANTHEM
OH751167OtherBUCKEYE
PA1021184600001OtherPA MEDICAID
OH000000225223OtherUNISON
OH2770961Medicaid
OH421800OtherWELLCARE
OHK04220731Medicare PIN