Provider Demographics
NPI:1013384866
Name:KLARISANA PHYSICIAN SERVICES PLLC
Entity type:Organization
Organization Name:KLARISANA PHYSICIAN SERVICES PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:BONNETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-945-6054
Mailing Address - Street 1:8670 WOLFF CT # 270
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80031-6956
Mailing Address - Country:US
Mailing Address - Phone:844-455-2747
Mailing Address - Fax:800-247-9785
Practice Address - Street 1:1240 S PARKER RD STE 100
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80231-2177
Practice Address - Country:US
Practice Address - Phone:000-000-0000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-27
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP8449208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty