Provider Demographics
NPI:1497728372
Name:CRINCOLI, MICHAEL G (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:G
Last Name:CRINCOLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6807 N 14TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-1133
Mailing Address - Country:US
Mailing Address - Phone:617-538-3650
Mailing Address - Fax:888-384-2827
Practice Address - Street 1:1601 E 19TH AVE STE 3650
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1282
Practice Address - Country:US
Practice Address - Phone:720-583-5379
Practice Address - Fax:888-384-2827
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-09
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA820362081S0010X
AZ442202081S0010X
COCDR.00005532081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAA23176Medicare ID - Type Unspecified
MA3171728Medicaid
MAG60380Medicare UPIN