Provider Demographics
NPI:1346379120
Name:MCCANN, MICHAEL J (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:MCCANN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6071 E WOODMEN RD
Mailing Address - Street 2:#340
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80923-2601
Mailing Address - Country:US
Mailing Address - Phone:719-591-8100
Mailing Address - Fax:719-591-8101
Practice Address - Street 1:6071 E WOODMEN RD
Practice Address - Street 2:#340
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80923-2601
Practice Address - Country:US
Practice Address - Phone:719-591-8100
Practice Address - Fax:719-591-8101
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO30798208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
E82162Medicare UPIN
L0618Medicare ID - Type Unspecified