Mile High Plastic Surgery a Professional LLC

Primary specialty

Plastic Surgery PhysicianTaxonomy code 208200000X

License

DR-50492 Issued in CO

Legal business name

MILE HIGH PLASTIC SURGERY A PROFESSIONAL LLC

Practice address

2595 Canyon Blvd Ste 360
Boulder, CO 80302-6745

Phone

(303) 440-7546

NPI assigned

Feb 27, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Nathan Roesner, D.O.NPI 1598886483

Title

Sole Member

Phone

(303) 552-1996

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 2

• Aura Skin and Plastic Surgery Doing business as
• Mile High Plastic Surgery Doing business as

Medicare fee-for-service enrollment

Enrolled in CO

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Nathan Roesner, D.O.

  • Surgery Physician
  • Boulder, CO
  • NPI 1598886483
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1330300800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1634688000000",
    "number": "1982978797",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8186 E 28TH DR",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802382515"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2595 CANYON BLVD STE 360",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803026745",
            "telephone_number": "303-440-7546"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MILE HIGH PLASTIC SURGERY A PROFESSIONAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-27",
        "last_updated": "2021-10-20",
        "certification_date": "2021-10-20",
        "status": "A",
        "authorized_official_last_name": "ROESNER",
        "authorized_official_first_name": "NATHAN",
        "authorized_official_title_or_position": "SOLE MEMBER",
        "authorized_official_telephone_number": "303-552-1996",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Plastic Surgery",
            "state": "CO",
            "license": "DR-50492",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "97705578",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Aura Skin and Plastic Surgery",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mile High Plastic Surgery",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mile High Plastic Surgery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kendra Miguez
• Migun in Boulder
• Mike Carpenter, DDS
• Mary Mikulinsky, MA
• Jessica L Milchak, PHARM.D.
• Elise Brigitte Miles, OTD, OTR/L
• Milestones Moments Co LLC
• Edward Lynn Miley, R PH
• Hillary Miling, PA-C
• Taylor Brooke Millard

• Plastic Surgery Physician in Boulder, CO
• Providers in Boulder, CO by specialty
• Plastic Surgery Physician in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.