MEDICARE: PREMIER FAMILY MEDICINE LLC

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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1992339790
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIER FAMILY MEDICINE LLC

Provider Business Mailing Address
First Line	:	2283 S MONACO PKWY STE 105
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80222-5845
Country	:	US
Telephone Number	:	720-531-2370
Fax Number	:	720-531-2370

Provider Business Practice Location Address
First Line	:	2283 S MONACO PKWY STE 105
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80222-5845
Country	:	US
Telephone Number	:	720-531-2370
Fax Number	:	720-531-2370

Authorized Official
Title or Position	:	OWNER
Name	:	MISBAH DARWEESH ZMILY
Credential	:	MD
Telephone Number	:	720-531-2370

Provider Enumeration Date	:	03/02/2020
Last Update Date	:	09/09/2020

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