Provider Demographics
NPI:1558517292
Name:WADE, MICHAEL DAVID (PA - C)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DAVID
Last Name:WADE
Suffix:
Gender:M
Credentials:PA - C
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:4900 S MONACO ST
Mailing Address - Street 2:#210
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-3486
Mailing Address - Country:US
Mailing Address - Phone:303-789-2663
Mailing Address - Fax:303-788-4871
Practice Address - Street 1:799 E HAMPDEN AVE
Practice Address - Street 2:#400
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-2700
Practice Address - Country:US
Practice Address - Phone:303-789-2663
Practice Address - Fax:303-788-4871
Is Sole Proprietor?:No
Enumeration Date:2008-08-13
Last Update Date:2022-02-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL085.003259363AS0400X
CO4192363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07535759Medicaid
CO07535759Medicaid
COP01607615Medicare PIN