Provider Demographics
NPI:1225040033
Name:LOCKWOOD, MICHAEL JAMES (PA)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:JAMES
Last Name:LOCKWOOD
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10900 W 44TH AVE # 300
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-2761
Mailing Address - Country:US
Mailing Address - Phone:303-993-1330
Mailing Address - Fax:303-284-4082
Practice Address - Street 1:12250 E ILIFF AVE
Practice Address - Street 2:#300
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-6318
Practice Address - Country:US
Practice Address - Phone:303-306-4321
Practice Address - Fax:720-524-1551
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
COPA.0000850363A00000X
CO00008530363A00000X
CO850363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO38406250Medicaid
CO38406250Medicaid
COCOA104547Medicare PIN
CO38406250Medicaid