Provider Demographics
NPI:1609899251
Name:MEDITZ, AMIE LYNN (MD)
Entity Type:Individual
Prefix:
First Name:AMIE
Middle Name:LYNN
Last Name:MEDITZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5450 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:303-415-8850
Mailing Address - Fax:303-415-8870
Practice Address - Street 1:4800 RIVERBEND RD
Practice Address - Street 2:SUITE 200
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-2636
Practice Address - Country:US
Practice Address - Phone:303-415-8850
Practice Address - Fax:303-415-8870
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0041567207RI0200X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO72327812Medicaid
H46244Medicare UPIN
CO72327812Medicaid