Provider Demographics
NPI:1982928867
Name:MY FAMILY DOCTOR PLLC
Entity Type:Organization
Organization Name:MY FAMILY DOCTOR PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LILA
Authorized Official - Middle Name:SHOSHANA
Authorized Official - Last Name:ROSENTHAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-928-0505
Mailing Address - Street 1:1225 CIMARRON DRIVE, SUITE 102
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026
Mailing Address - Country:US
Mailing Address - Phone:303-444-7150
Mailing Address - Fax:
Practice Address - Street 1:1225 CIMARRON DR
Practice Address - Street 2:UNIT 102
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-3812
Practice Address - Country:US
Practice Address - Phone:303-444-7150
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-21
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty