Provider Demographics
NPI:1518925718
Name:SHELL, MICHAEL GRAY (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:GRAY
Last Name:SHELL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1551 PROFESSIONAL LN UNIT 180
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-6970
Mailing Address - Country:US
Mailing Address - Phone:720-307-7246
Mailing Address - Fax:
Practice Address - Street 1:1551 PROFESSIONAL LN UNIT 180
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-6970
Practice Address - Country:US
Practice Address - Phone:720-476-3421
Practice Address - Fax:720-502-5271
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO355652081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
L0558Medicare ID - Type Unspecified
F05151Medicare UPIN