1801017785 NPI number — ANNETTE J MICHAEL M.D.

Table of content: ANNETTE J MICHAEL M.D. (NPI 1801017785)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801017785 NPI number — ANNETTE J MICHAEL M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MICHAEL
Provider First Name:
ANNETTE
Provider Middle Name:
J
Provider Name Prefix Text:
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:
CHAKKALAKAL
Provider Other First Name:
ANNETTE
Provider Other Middle Name:
J
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1801017785
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/06/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 840862
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75284-0862
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-377-7638
Provider Business Mailing Address Fax Number:
303-780-0787

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8000 E MAPLEWOOD AVE STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENWOOD VILLAGE
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80111-4727
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-438-3999
Provider Business Practice Location Address Fax Number:
720-439-9500
Provider Enumeration Date:
05/01/2007

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: 207L00000X , with the licence number:  46859 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207L00000X , with the licence number: P1171 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207LP3000X , with the licence number: P1171 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207LP3000X , with the licence number: 46859 , 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: 58707221 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1801017785 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".