Provider Demographics
NPI:1639695083
Name:GIACOPELLI, MICHAEL R (PA-C)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:R
Last Name:GIACOPELLI
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:3702 S TIMBERLINE RD STE A
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-3625
Mailing Address - Country:US
Mailing Address - Phone:970-207-9773
Mailing Address - Fax:970-484-8667
Practice Address - Street 1:8225 W 20TH ST
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-3037
Practice Address - Country:US
Practice Address - Phone:970-378-1414
Practice Address - Fax:970-348-1515
Is Sole Proprietor?:No
Enumeration Date:2017-08-17
Last Update Date:2020-04-13
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Provider Licenses
StateLicense IDTaxonomies
CO0005938363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical