Provider Demographics
NPI:1497710859
Name:MUZNY, LISE COTTER (MD)
Entity Type:Individual
Prefix:DR
First Name:LISE
Middle Name:COTTER
Last Name:MUZNY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:5450 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-2709
Mailing Address - Country:US
Mailing Address - Phone:303-415-8900
Mailing Address - Fax:303-443-6476
Practice Address - Street 1:2995 BASELINE RD
Practice Address - Street 2:SUITE 210
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-2318
Practice Address - Country:US
Practice Address - Phone:303-415-8900
Practice Address - Fax:303-443-6476
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0037563207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO57271372Medicaid
CO57271372Medicaid
CO323893YLL6Medicare PIN
COH25748Medicare UPIN