Provider Demographics
NPI:1427243146
Name:MILE HIGH SPORTS AND REHABILITATION MEDICINE, PC
Entity type:Organization
Organization Name:MILE HIGH SPORTS AND REHABILITATION MEDICINE, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:Y
Authorized Official - Last Name:CHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-331-6744
Mailing Address - Street 1:2490 W 26TH AVENUE
Mailing Address - Street 2:SUITE 10-A
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80211
Mailing Address - Country:US
Mailing Address - Phone:303-331-6744
Mailing Address - Fax:303-331-6839
Practice Address - Street 1:2490 W 26TH AVENUE
Practice Address - Street 2:SUITE 10-A
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80211
Practice Address - Country:US
Practice Address - Phone:303-331-6744
Practice Address - Fax:303-331-6839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-06
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO33675208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
803515Medicare PIN
F86708Medicare UPIN