Provider Demographics
NPI:1518377613
Name:BRASSIL, MICHELLE ELIZABETH (MD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ELIZABETH
Last Name:BRASSIL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:ELIZABETH
Other - Last Name:LALONDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1800 15TH ST STE 210
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80631-4563
Mailing Address - Country:US
Mailing Address - Phone:970-810-4543
Mailing Address - Fax:970-810-4226
Practice Address - Street 1:1800 15TH ST STE 210
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80631-4563
Practice Address - Country:US
Practice Address - Phone:970-810-4543
Practice Address - Fax:970-810-4226
Is Sole Proprietor?:No
Enumeration Date:2014-04-29
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD467207208100000X
CODR.00649532081H0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081H0002XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationHospice and Palliative Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation