Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207PP0204X | Pediatric Emergency Physician | 05-28654 | KS |
N | 207PP0204X | Pediatric Emergency Physician | 108841 | MO |
Y | 207PP0204X | Pediatric Emergency Physician | 63281 | CO |
NPI | 1104876663 |
---|---|
Provider Name | Dr. Jeffrey Gerard Michael |
First Address | Aurora, CO 80042-0429 |
Second Address | Aurora, CO 80045-7106 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2006 |
Last Update Date | 29/01/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G77798 | (02) |