Provider Demographics
NPI:1154691426
Name:HEALTHY HABITS PEDIATRICS, PLLC
Entity type:Organization
Organization Name:HEALTHY HABITS PEDIATRICS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAZELTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-972-2000
Mailing Address - Street 1:6179 S BALSAM WAY
Mailing Address - Street 2:SUITE 205
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80123-3091
Mailing Address - Country:US
Mailing Address - Phone:303-972-2000
Mailing Address - Fax:720-245-2690
Practice Address - Street 1:6179 S BALSAM WAY
Practice Address - Street 2:SUITE 205
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80123-3091
Practice Address - Country:US
Practice Address - Phone:303-972-2000
Practice Address - Fax:720-245-2690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-04
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO31178208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO03170578Medicaid
COF39423Medicare UPIN