Provider Demographics
NPI:1205188794
Name:HIGHLANDS INTEGRATIVE PEDIATICS, PC
Entity type:Organization
Organization Name:HIGHLANDS INTEGRATIVE PEDIATICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KONO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:720-941-8983
Mailing Address - Street 1:2650 18TH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80211-3932
Mailing Address - Country:US
Mailing Address - Phone:720-941-8983
Mailing Address - Fax:
Practice Address - Street 1:2650 18TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80211-3932
Practice Address - Country:US
Practice Address - Phone:720-941-8983
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-08
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO45399208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty