Provider Demographics
NPI:1639533656
Name:FAMILY MEDICINE ASSOCIATES
Entity Type:Organization
Organization Name:FAMILY MEDICINE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELISABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:KANDEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-465-2323
Mailing Address - Street 1:1022 DEPOT HILL RD
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-1068
Mailing Address - Country:US
Mailing Address - Phone:303-465-2323
Mailing Address - Fax:303-465-1260
Practice Address - Street 1:1022 DEPOT HILL RD
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-1068
Practice Address - Country:US
Practice Address - Phone:303-465-2323
Practice Address - Fax:303-465-1260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-06
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0004585363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty