Healthcare Provider Details

I. General information

NPI: 1700153301
Provider Name (Legal Business Name): CASTLE PINES FAMILY PRACTICE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2011
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7280 LAGAE RD
CASTLE PINES CO
80108-9452
US

IV. Provider business mailing address

7280 LAGAE RD
CASTLE PINES CO
80108-9452
US

V. Phone/Fax

Practice location:
  • Phone: 303-814-0505
  • Fax:
Mailing address:
  • Phone: 303-814-0505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: LAWRENCE S WILNER
Title or Position: MD/OWNER
Credential: MD
Phone: 303-814-0505