1902069545 NPI number — DR. MICHELE ANGELEC STREETER M.D.

Table of content: DR. MICHELE ANGELEC STREETER M.D. (NPI 1902069545)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902069545 NPI number — DR. MICHELE ANGELEC STREETER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STREETER
Provider First Name:
MICHELE
Provider Middle Name:
ANGELEC
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
COX
Provider Other First Name:
MICHELE
Provider Other Middle Name:
ANGELEC
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1902069545
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/11/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 429
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALIDA
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81201-0429
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-530-2000
Provider Business Mailing Address Fax Number:
719-539-5068

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 RUSH DR FL 3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALIDA
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81201-9627
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-530-2309
Provider Business Practice Location Address Fax Number:
719-539-5068
Provider Enumeration Date:
07/03/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207YX0007X , with the licence number:  52421 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)