MEDICARE: MICHELLE LYNN TOLLEFSON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	44342	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033167192
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE LYNN TOLLEFSON MD

Provider Business Mailing Address
First Line	:	1107 S LEMAY AVE STE 100
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-3955
Country	:	US
Telephone Number	:	970-495-8400
Fax Number	:

Provider Business Practice Location Address
First Line	:	1107 S LEMAY AVE STE 100
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-3955
Country	:	US
Telephone Number	:	970-495-8400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	05/26/2009

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