Provider Demographics
NPI:1578102059
Name:ALTITUDE KIDNEY HEALTH PLLC
Entity Type:Organization
Organization Name:ALTITUDE KIDNEY HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:BROOKENS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:720-500-3439
Mailing Address - Street 1:1260 S PARKER RD STE 202
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-8068
Mailing Address - Country:US
Mailing Address - Phone:720-500-3439
Mailing Address - Fax:920-500-3559
Practice Address - Street 1:350 S 400 E
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-4932
Practice Address - Country:US
Practice Address - Phone:720-500-3439
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-31
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT11249743-8905OtherUT CDS NUMBER
UT11249743-1205OtherUT MEDICAL LICENSE