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General NPI Number Information
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NPI Number | 1821155268
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Entity Type | Organization
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Legal Business Name | INTEGRATED FAMILY MEDICINE PLLC
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Dates
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Enumeration Date | 01/03/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 110 W HARVARD ST STE 2
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City | FORT COLLINS
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State | CO
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Zip | 80525-5217
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Country | US
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Telephone | 970-282-1173
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Fax | 970-282-1175
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Provider Business Mailing Address
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Address Line | 110 W HARVARD ST STE 2
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City | FORT COLLINS
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State | CO
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Zip | 80525-5217
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Country | US
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Telephone | 970-282-1173
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Fax | 970-282-1175
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Authorized Official
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Title or Position | OWNER PHYSICIAN
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Name | MS. MARIAN BURSTEN
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Credential | M.D. P.H.D.
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Telephone | 970-282-1173
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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 | 42461
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License Number State | CO
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