Healthcare Provider Details

I. General information

NPI: 1982928867
Provider Name (Legal Business Name): MY FAMILY DOCTOR PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2010
Last Update Date: 05/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 CIMARRON DR UNIT 102
LAFAYETTE CO
80026-3812
US

IV. Provider business mailing address

1225 CIMARRON DRIVE, SUITE 102
LAFAYETTE CO
80026
US

V. Phone/Fax

Practice location:
  • Phone: 303-444-7150
  • Fax:
Mailing address:
  • Phone: 303-444-7150
  • 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: DR. LILA SHOSHANA ROSENTHAL
Title or Position: PARTNER
Credential: M.D.
Phone: 303-928-0505