Provider Demographics
NPI:1578585071
Name:BAGLEY, MICHAEL C (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:C
Last Name:BAGLEY
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:80 HEALTH PARK DR
Mailing Address - Street 2:SUITE 230
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-9584
Mailing Address - Country:US
Mailing Address - Phone:303-665-2603
Mailing Address - Fax:303-665-2605
Practice Address - Street 1:400 W 144TH AVE
Practice Address - Street 2:SUITE 230
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80023-9307
Practice Address - Country:US
Practice Address - Phone:303-469-6790
Practice Address - Fax:303-469-6794
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2014-12-02
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Provider Licenses
StateLicense IDTaxonomies
CO#45154207X00000X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO840864756OtherTAX IDENTIFICATION
H44880Medicare UPIN
COCA105126BMedicare PIN
20-5179209OtherTAX ID