Basic Information
| Provider Information | |||||||||
| NPI: | 1154761070 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PLACHTA | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | GABRIEL | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2 SOUTH CASCADE AVENUE | ||||||||
| Address2: | SUITE 140 | ||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809031604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195282950 | ||||||||
| FaxNumber: | 7195382961 | ||||||||
| Practice Location | |||||||||
| Address1: | 5115 FONTAINE BOULEVARD | ||||||||
| Address2: | |||||||||
| City: | FOUNTAIN | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80817 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195221133 | ||||||||
| FaxNumber: | 7193926937 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2013 | ||||||||
| LastUpdateDate: | 11/07/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | LL36034 | SC | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.