Provider Demographics
NPI:1316615693
Name:FUNCTIONAL & METABOLIC MEDICINE OF COLORADO
Entity type:Organization
Organization Name:FUNCTIONAL & METABOLIC MEDICINE OF COLORADO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SIPAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:720-791-2911
Mailing Address - Street 1:191 UNIVERSITY BLVD STE 522
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-4613
Mailing Address - Country:US
Mailing Address - Phone:720-791-2911
Mailing Address - Fax:
Practice Address - Street 1:26 W DRY CREEK CIR STE 520
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-8064
Practice Address - Country:US
Practice Address - Phone:720-791-2911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-01
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center