Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | 20107 | CO |
NPI | 1073587077 |
---|---|
Provider Name | Dr. Michael Alan Blieden |
First Address | Denver, CO 80220-3808 |
Second Address | Denver, CO 80220-3808 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2006 |
Last Update Date | 07/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01201078 | (05) | CO |
F73746 | (02) | CO |