| Lisa A Iacofano Md Pc | |
|
335 W South Boulder Rd Suite 6 Louisville CO 80027-1196 | |
| (303) 665-0900 | |
| (303) 926-1986 |
| Full Name | Lisa A Iacofano Md Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 335 W South Boulder Rd, Louisville, Colorado |
| Authorized Official Name and Position | Lisa Ann Iacofano (OWNER/PHYSICIAN) |
| Authorized Official Contact | 3036650900 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lisa A Iacofano Md Pc Po Box 21150 Boulder CO 80308-4150 Ph: (303) 665-0900 | Lisa A Iacofano Md Pc 335 W South Boulder Rd Suite 6 Louisville CO 80027-1196 Ph: (303) 665-0900 |
| NPI Number | 1760641070 |
|---|---|
| Provider Enumeration Date | 06/03/2008 |
| Last Update Date | 01/22/2020 |
| Medicare PECOS PAC ID | 8527126606 |
|---|---|
| Medicare Enrollment ID | O20081017000404 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760641070 | NPI | - | NPPES |
| 01312677 | Medicaid | CO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 31267 (Colorado) | Primary |
| Provider Name | Lisa A Iacofano |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1508891011 PECOS PAC ID: 4880619980 Enrollment ID: I20051007000559 |
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