Provider Demographics
NPI:1346237807
Name:WAHL, MICHAEL R (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:R
Last Name:WAHL
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Gender:M
Credentials:MD
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Mailing Address - Street 1:11700 W 2ND PL
Mailing Address - Street 2:SUITE 350
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-1704
Mailing Address - Country:US
Mailing Address - Phone:303-595-2727
Mailing Address - Fax:303-595-2626
Practice Address - Street 1:11700 W 2ND PL
Practice Address - Street 2:SUITE 350
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-1704
Practice Address - Country:US
Practice Address - Phone:303-595-2727
Practice Address - Fax:303-595-2626
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2022-02-08
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Provider Licenses
StateLicense IDTaxonomies
CO41599207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO84987863Medicaid
COC498638Medicare PIN
CO84987863Medicaid