Provider Demographics
NPI:1871501189
Name:SPARR, MICHAEL C (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:C
Last Name:SPARR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7150 CAMPUS DR STE 100
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-3178
Mailing Address - Country:US
Mailing Address - Phone:719-636-3333
Mailing Address - Fax:719-636-0025
Practice Address - Street 1:7150 CAMPUS DR STE 100
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-3178
Practice Address - Country:US
Practice Address - Phone:719-636-3333
Practice Address - Fax:719-636-0025
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO37836208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC801059Medicare PIN
COG96534Medicare UPIN