Basic Information
| Provider Information | |||||||||
| NPI: | 1346551637 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MILTENBERG | ||||||||
| FirstName: | LAUREN | ||||||||
| MiddleName: | WITTE | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1200 E ELIZABETH ST | ||||||||
| Address2: | FORT COLLINS YOUTH CLINIC | ||||||||
| City: | FORT COLLINS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805244007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9702679510 | ||||||||
| FaxNumber: | 9704826938 | ||||||||
| Practice Location | |||||||||
| Address1: | 1200 E ELIZABETH ST | ||||||||
| Address2: | FORT COLLINS YOUTH CLINIC | ||||||||
| City: | FORT COLLINS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805244007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9702679510 | ||||||||
| FaxNumber: | 9704826938 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2010 | ||||||||
| LastUpdateDate: | 02/21/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 0052611 | CO | Y | Allopathic & Osteopathic Physicians | Pediatrics | 207K00000X | 2010017743 | MO | N | Allopathic & Osteopathic Physicians | Allergy & Immunology |
No ID Information.