Provider Demographics
NPI:1356526776
Name:ROCKY MOUNTAIN PEDIATRIC PULMONOLOGY PC
Entity type:Organization
Organization Name:ROCKY MOUNTAIN PEDIATRIC PULMONOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:LEE
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSAKOW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-831-9853
Mailing Address - Street 1:4545 E 9TH AVE STE 375
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-3987
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4545 E 9TH AVE STE 375
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-3987
Practice Address - Country:US
Practice Address - Phone:303-831-9853
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-03
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty