Basic Information
| Provider Information | |||||||||
| NPI: | 1649486093 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LAKEVIEW FAMILY MEDICINE PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6169 S. BALSAM WAY | ||||||||
| Address2: | SUITE 220 | ||||||||
| City: | LITTLETON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80123 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3039630566 | ||||||||
| FaxNumber: | 3039630589 | ||||||||
| Practice Location | |||||||||
| Address1: | 6169 S. BALSAM WAY | ||||||||
| Address2: | SUITE 220 | ||||||||
| City: | LITTLETON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80123 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3039630566 | ||||||||
| FaxNumber: | 3039630589 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2007 | ||||||||
| LastUpdateDate: | 07/28/2010 | ||||||||
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| AuthorizedOfficialLastName: | VALENZIANO | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3039630566 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 24296 | CO | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.