Provider Demographics
NPI:1831173525
Name:ROSENTHAL, LILA S (MD)
Entity type:Individual
Prefix:DR
First Name:LILA
Middle Name:S
Last Name:ROSENTHAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 CIMARRON DR UNIT 102
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-3824
Mailing Address - Country:US
Mailing Address - Phone:303-444-7150
Mailing Address - Fax:303-557-6274
Practice Address - Street 1:1225 CIMARRON DR UNIT 102
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-3824
Practice Address - Country:US
Practice Address - Phone:303-444-7150
Practice Address - Fax:303-557-6274
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO45788207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO69278202Medicaid
BR9570359OtherDEA
BR9570359OtherDEA