Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 40740 | CO |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 40740 | CO |
NPI | 1134216286 |
---|---|
Provider Name | Michelle Wolcott |
First Address | Aurora, CO 80042-0429 |
Second Address | Aurora, CO 80045-2545 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/10/2006 |
Last Update Date | 16/05/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
66322863 | (05) | CO |