Provider Demographics
NPI:1588767446
Name:FOOTHILLS FAMILY PRACTICE PC
Entity type:Organization
Organization Name:FOOTHILLS FAMILY PRACTICE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:DUNN
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:303-986-2274
Mailing Address - Street 1:850 E HARVARD AVE
Mailing Address - Street 2:SUITE 265
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-5073
Mailing Address - Country:US
Mailing Address - Phone:303-986-2274
Mailing Address - Fax:303-986-2205
Practice Address - Street 1:850 E HARVARD AVE
Practice Address - Street 2:SUITE 265
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-5073
Practice Address - Country:US
Practice Address - Phone:303-986-2274
Practice Address - Fax:303-986-2205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COM8908Medicare ID - Type Unspecified