Provider Demographics
NPI:1851356737
Name:CLINGENPEEL, MICHELE LEE (M D)
Entity Type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:LEE
Last Name:CLINGENPEEL
Suffix:
Gender:F
Credentials:M D
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:CLINGENPEEL
Other - Last Name:PTASZKIEWICZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2127 E HARMONY RD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80528-3405
Mailing Address - Country:US
Mailing Address - Phone:970-297-6250
Mailing Address - Fax:970-297-6260
Practice Address - Street 1:2127 E HARMONY RD
Practice Address - Street 2:STE 140
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80528-3405
Practice Address - Country:US
Practice Address - Phone:970-297-6250
Practice Address - Fax:970-297-6260
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301077135207Q00000X
CO50593207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO71973052Medicaid
COCOAAA3143Medicare PIN
MI4822402-10Medicaid
COCOAAA3143Medicare PIN
CO71973052Medicaid