Provider Demographics
NPI:1073578894
Name:MCCARTY, MICHAEL COREY (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:COREY
Last Name:MCCARTY
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:5450 WESTERN AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-2709
Mailing Address - Country:US
Mailing Address - Phone:303-415-7599
Mailing Address - Fax:303-530-5474
Practice Address - Street 1:6685 GUNPARK DR
Practice Address - Street 2:STE. 110
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-3388
Practice Address - Country:US
Practice Address - Phone:303-415-7599
Practice Address - Fax:303-530-5474
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2022-07-21
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Provider Licenses
StateLicense IDTaxonomies
CO42850207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO11305046Medicaid
COCOA107378Medicare PIN
CO11305046Medicaid