Basic Information
| Provider Information | |||||||||
| NPI: | 1851548648 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FALL | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 535 16TH ST | ||||||||
| Address2: | STE 750 | ||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802024228 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3038254646 | ||||||||
| FaxNumber: | 3038253215 | ||||||||
| Practice Location | |||||||||
| Address1: | 535 16TH ST | ||||||||
| Address2: | STE 750 | ||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802024228 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3038254646 | ||||||||
| FaxNumber: | 3038253215 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/22/2008 | ||||||||
| LastUpdateDate: | 06/06/2017 | ||||||||
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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 | 207RP1001X | O-1046 | ID | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | 207R00000X | 47743 | CO | N | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 12783340 | 05 | CO | MEDICAID |