MEDICARE: INTEGRATED FAMILY MEDICINE 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	42461	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1710942339	OTHER	CO	NPI - INDIVIDUAL

General Provider Information

NPI Number	:	1821155268
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTEGRATED FAMILY MEDICINE PLLC

Provider Business Mailing Address
First Line	:	110 W HARVARD ST
Second Line	:	STE 2
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-5217
Country	:	US
Telephone Number	:	970-282-1173
Fax Number	:	970-282-1175

Provider Business Practice Location Address
First Line	:	110 W HARVARD ST
Second Line	:	STE 2
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-5217
Country	:	US
Telephone Number	:	970-282-1173
Fax Number	:	970-282-1175

Authorized Official
Title or Position	:	OWNER PHYSICIAN
Name	:	MS. MARIAN BURSTEN
Credential	:	M.D. P.H.D.
Telephone Number	:	970-282-1173

Provider Enumeration Date	:	01/03/2007
Last Update Date	:	08/22/2020

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