Provider Demographics
NPI:1588055255
Name:INTERNAL AESTHETIC MEDICINE, LLC
Entity type:Organization
Organization Name:INTERNAL AESTHETIC MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:CARRIERE
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:303-814-1854
Mailing Address - Street 1:2400 S RUSSELLVILLE RD
Mailing Address - Street 2:
Mailing Address - City:FRANKTOWN
Mailing Address - State:CO
Mailing Address - Zip Code:80116-8557
Mailing Address - Country:US
Mailing Address - Phone:303-814-1854
Mailing Address - Fax:303-778-0202
Practice Address - Street 1:2400 S RUSSELLVILLE RD
Practice Address - Street 2:
Practice Address - City:FRANKTOWN
Practice Address - State:CO
Practice Address - Zip Code:80116-8557
Practice Address - Country:US
Practice Address - Phone:303-814-1854
Practice Address - Fax:303-778-0202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-16
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0030907207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO325654Medicare PIN