# IANNOTTI LIFESTYLE CLINIC PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1396190831
- **Authorized official:** MICHAEL ROBERT IANNOTTI MD (PHYSICIAN/ OWNER)
- **Authorized official phone:** (720) 773-1352

## Contact information

- **Practice address:** 150 OLD LARAMIE TRL E, SUITE 210, LAFAYETTE, CO 80026-7018
- **Practice address phone:** (720) 773-1352
- **Practice address fax:** (303) 604-6958
- **Mailing address:** 150 OLD LARAMIE TRL E, SUITE 210, LAFAYETTE, CO 80026-7018
- **Mailing address phone:** (720) 773-1352
- **Mailing address fax:** (303) 604-6958

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | DR.0039567 | CO | Yes |

## Other

- **Enumeration date:** 05/03/2016
- **Last updated:** 07/26/2016