MEDICARE: DR. ANNE-LISE HULTSCH M.D.

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	207N00000X	Dermatology Physician	35113	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	:	1093781007
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANNE-LISE HULTSCH M.D.

Provider Business Mailing Address
First Line	:	3726 S TIMBERLINE RD
Second Line	:	SUITE101
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-3483
Country	:	US
Telephone Number	:	970-221-5795
Fax Number	:	970-221-1371

Provider Business Practice Location Address
First Line	:	3726 S TIMBERLINE RD
Second Line	:	SUITE101
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-3483
Country	:	US
Telephone Number	:	970-221-5795
Fax Number	:	970-221-1371

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

Provider Enumeration Date	:	02/28/2006
Last Update Date	:	01/17/2013

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