Provider Demographics
NPI:1851548648
Name:FALL, MICHAEL J (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:FALL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:535 16TH ST
Mailing Address - Street 2:STE 750
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80202-4228
Mailing Address - Country:US
Mailing Address - Phone:303-825-4646
Mailing Address - Fax:303-825-3215
Practice Address - Street 1:535 16TH ST
Practice Address - Street 2:STE 750
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80202-4228
Practice Address - Country:US
Practice Address - Phone:303-825-4646
Practice Address - Fax:303-825-3215
Is Sole Proprietor?:No
Enumeration Date:2008-08-22
Last Update Date:2017-06-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IDO-1046207RP1001X
CO47743207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO12783340Medicaid
COCO304837Medicare PIN