Provider Demographics
NPI:1578105912
Name:METAMORPHOSIS HEALTH LLC
Entity type:Organization
Organization Name:METAMORPHOSIS HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:AUDREY
Authorized Official - Middle Name:G
Authorized Official - Last Name:BAUER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:202-468-0227
Mailing Address - Street 1:4550 E CHERRY CREEK SOUTH DR APT 205
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80246-1539
Mailing Address - Country:US
Mailing Address - Phone:202-468-0227
Mailing Address - Fax:
Practice Address - Street 1:4550 E CHERRY CREEK SOUTH DR APT 205
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80246-1539
Practice Address - Country:US
Practice Address - Phone:202-468-0227
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-16
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty