1649288473 NPI number — DR. DAVID MICHAEL ODELL MD

Table of content: DR. DAVID MICHAEL ODELL MD (NPI 1649288473)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649288473 NPI number — DR. DAVID MICHAEL ODELL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ODELL
Provider First Name:
DAVID
Provider Middle Name:
MICHAEL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649288473
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/15/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15400 W 64TH AVE UNIT 9E
Provider Second Line Business Mailing Address:
SUITE 14
Provider Business Mailing Address City Name:
ARVADA
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80007-6852
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-422-3909
Provider Business Mailing Address Fax Number:
303-422-2192

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15400 W 64TH AVE UNIT 9E
Provider Second Line Business Practice Location Address:
SUITE 14
Provider Business Practice Location Address City Name:
ARVADA
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80007-6852
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-422-3909
Provider Business Practice Location Address Fax Number:
303-422-2192
Provider Enumeration Date:
08/04/2006

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: 207Q00000X , with the licence number:  35741 , 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)

  • Identifier: 01357417 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 015122 . This is a "KAISER COMMERCIAL NUMBER" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




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