| Dynamic Athlete Pllc | |
|
1790 30th St Ste 270 Boulder CO 80301-1085 | |
| (720) 310-0345 | |
| Not Available |
| Full Name | Dynamic Athlete Pllc |
|---|---|
| Speciality | Internal Medicine |
| Location | 1790 30th St Ste 270, Boulder, Colorado |
| Authorized Official Name and Position | Aneesh Garg (PRESIDENT/CMO) |
| Authorized Official Contact | 7203100345 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dynamic Athlete Pllc 2995 55th St # 19063 Boulder CO 80301-7200 Ph: () - | Dynamic Athlete Pllc 1790 30th St Ste 270 Boulder CO 80301-1085 Ph: (720) 310-0345 |
| NPI Number | 1841986494 |
|---|---|
| Provider Enumeration Date | 04/17/2023 |
| Last Update Date | 04/17/2023 |
| Medicare PECOS PAC ID | 7113384033 |
|---|---|
| Medicare Enrollment ID | O20230608002129 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841986494 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RS0010X | Internal Medicine - Sports Medicine | (* (Not Available)) | Primary |
| Provider Name | Aneesh Garg |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1346537370 PECOS PAC ID: 1052537768 Enrollment ID: I20230224002667 |
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