Provider Demographics
NPI:1407969595
Name:EASON-DELHOUGNE, MICHELLE BELLE (MD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:BELLE
Last Name:EASON-DELHOUGNE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2352 MEADOWS BLVD
Mailing Address - Street 2:STE 300
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80109-8406
Mailing Address - Country:US
Mailing Address - Phone:720-455-3750
Mailing Address - Fax:720-455-3751
Practice Address - Street 1:2352 MEADOWS BLVD
Practice Address - Street 2:STE 300
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80109-8406
Practice Address - Country:US
Practice Address - Phone:720-455-3750
Practice Address - Fax:720-455-3751
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2014-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCO 39425207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
COH35276Medicare UPIN
COC488428Medicare PIN