Provider Demographics
NPI:1184940884
Name:MICHAEL A. TRALLA M.D., P.C.
Entity type:Organization
Organization Name:MICHAEL A. TRALLA M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:TRALLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-425-0440
Mailing Address - Street 1:3555 LUTHERAN PKWY
Mailing Address - Street 2:STE 160
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-6017
Mailing Address - Country:US
Mailing Address - Phone:303-425-0440
Mailing Address - Fax:303-425-4086
Practice Address - Street 1:3555 LUTHERAN PKWY
Practice Address - Street 2:STE 160
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-6017
Practice Address - Country:US
Practice Address - Phone:303-425-0440
Practice Address - Fax:303-425-4086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-20
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO21450174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty