Provider Demographics
NPI:1972534329
Name:GREEN, MICHAEL AARON (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:AARON
Last Name:GREEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10900 W 44TH AVE UNIT 200
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-2742
Mailing Address - Country:US
Mailing Address - Phone:720-923-1239
Mailing Address - Fax:303-284-4082
Practice Address - Street 1:10900 W 44TH AVE, SUITE #200
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-2742
Practice Address - Country:US
Practice Address - Phone:303-379-9371
Practice Address - Fax:303-284-4082
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO29371207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01293711Medicaid
CO01293711Medicaid
NM00040873Medicaid
TXE67179Medicare UPIN
CO01293711Medicaid
CO01293711Medicaid