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General NPI Number Information
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NPI Number | 1417055070
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Entity Type | Individual
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Provider Name | MICHAEL ROBERT IANNOTTI M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 07/18/2016
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Provider Practice Location Address
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Address Line | 150 OLD LARAMIE TRL E SUITE 210
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City | LAFAYETTE
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State | CO
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Zip | 80026-7018
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Country | US
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Telephone | 720-773-1352
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Fax | 303-604-6958
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Provider Business Mailing Address
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Address Line | 150 OLD LARAMIE TRL E SUITE 210
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City | LAFAYETTE
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State | CO
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Zip | 80026-7018
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Country | US
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Telephone | 720-773-1352
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Fax | 303-604-6958
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | DR.0039567
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License Number State | CO
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