MEDICARE: LYNN M IWANIEC

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	207R00000X	Internal Medicine Physician	36226	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	:	1235190661
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYNN M IWANIEC

Provider Business Mailing Address
First Line	:	2000 S COLORADO BLVD
Second Line	:	ANNEX BLDG, # 420
City	:	DENVER
State	:	CO
Zip	:	80222-7900
Country	:	US
Telephone Number	:	720-524-1550
Fax Number	:	720-524-1551

Provider Business Practice Location Address
First Line	:	2000 S COLORADO BLVD
Second Line	:	ANNEX BLDG, # 420
City	:	DENVER
State	:	CO
Zip	:	80222-7900
Country	:	US
Telephone Number	:	720-524-1550
Fax Number	:	720-524-1551

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

Provider Enumeration Date	:	03/28/2006
Last Update Date	:	07/08/2007

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Directions to “ LYNN M IWANIEC ” Practice Location

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