Provider Demographics
NPI:1689715088
Name:TRALLA, MICHAEL A (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:TRALLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3555 LUTHERAN PKWY
Mailing Address - Street 2:STE 160
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-6021
Mailing Address - Country:US
Mailing Address - Phone:303-425-0449
Mailing Address - Fax:303-425-0449
Practice Address - Street 1:3555 LUTHERAN PKWY W
Practice Address - Street 2:STE 160
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-6013
Practice Address - Country:US
Practice Address - Phone:303-425-0449
Practice Address - Fax:303-425-0449
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO21450207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01214501Medicaid
CO01214501Medicaid