MEDICARE: 5TH AVE FAMILY PRACTICE & COSMETICS PLLC

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	207Q00000X	Family Medicine Physician	DR.0057175	CO

General Provider Information

NPI Number	:	1346775343
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	5TH AVE FAMILY PRACTICE & COSMETICS PLLC

Provider Business Mailing Address
First Line	:	2044 CLINTON ST
Second Line	:	UNIT B
City	:	AURORA
State	:	CO
Zip	:	80010-1003
Country	:	US
Telephone Number	:	303-360-7472
Fax Number	:

Provider Business Practice Location Address
First Line	:	2044 CLINTON ST
Second Line	:	UNIT B
City	:	AURORA
State	:	CO
Zip	:	80010-1003
Country	:	US
Telephone Number	:	303-360-7472
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	PRISCILLA OWUSU-FRIMPONG
Credential	:
Telephone Number	:	303-360-7472

Provider Enumeration Date	:	04/27/2017
Last Update Date	:	10/31/2017

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