Provider Demographics
NPI:1881656148
Name:NOBLE, MICHAEL J (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:NOBLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2405 RESEARCH PKWY
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-1044
Mailing Address - Country:US
Mailing Address - Phone:719-522-1133
Mailing Address - Fax:719-264-1772
Practice Address - Street 1:2405 RESEARCH PKWY
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-1044
Practice Address - Country:US
Practice Address - Phone:719-522-1133
Practice Address - Fax:719-264-1772
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO28661207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01286616Medicaid
CO387464ZL1PMedicare PIN
CO01286616Medicaid