Provider Demographics
NPI:1821155268
Name:INTEGRATED FAMILY MEDICINE PLLC
Entity Type:Organization
Organization Name:INTEGRATED FAMILY MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BURSTEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD PHD
Authorized Official - Phone:970-282-1173
Mailing Address - Street 1:110 W HARVARD ST
Mailing Address - Street 2:STE 2
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-5217
Mailing Address - Country:US
Mailing Address - Phone:970-282-1173
Mailing Address - Fax:970-282-1175
Practice Address - Street 1:110 W HARVARD ST
Practice Address - Street 2:STE 2
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-5217
Practice Address - Country:US
Practice Address - Phone:970-282-1173
Practice Address - Fax:970-282-1175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO42461207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1710942339OtherNPI - INDIVIDUAL
CO1710942339OtherNPI - INDIVIDUAL