Provider Demographics
NPI:1639144975
Name:DEMOS, MICHAEL ALEXANDER (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ALEXANDER
Last Name:DEMOS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1 MERCADO ST
Mailing Address - Street 2:STE 130
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-7306
Mailing Address - Country:US
Mailing Address - Phone:970-247-1120
Mailing Address - Fax:970-247-1128
Practice Address - Street 1:1 MERCADO ST
Practice Address - Street 2:STE 130
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-7306
Practice Address - Country:US
Practice Address - Phone:970-247-1120
Practice Address - Fax:970-247-1128
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO19115207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO91500207Medicaid
CO91500207Medicaid
COC801960Medicare PIN
COCOA100251Medicare PIN
COCOAAA1999Medicare PIN