Provider Demographics
NPI:1033156427
Name:LEIFESTE, MARK G (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:G
Last Name:LEIFESTE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2086
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80522-2086
Mailing Address - Country:US
Mailing Address - Phone:303-444-3443
Mailing Address - Fax:970-221-3730
Practice Address - Street 1:4770 BASELINE RD
Practice Address - Street 2:SUITE #300
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-2666
Practice Address - Country:US
Practice Address - Phone:303-449-6577
Practice Address - Fax:303-447-1880
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO23486174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist