Provider Demographics
NPI:1245348036
Name:MCDONNELL, MICHAELA W (MD)
Entity type:Individual
Prefix:
First Name:MICHAELA
Middle Name:W
Last Name:MCDONNELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3455 S YARROW ST
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80227-5031
Mailing Address - Country:US
Mailing Address - Phone:303-989-5231
Mailing Address - Fax:303-989-9785
Practice Address - Street 1:3455 S YARROW ST
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80227-5031
Practice Address - Country:US
Practice Address - Phone:303-989-5231
Practice Address - Fax:303-989-9785
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO28751207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01287515Medicaid
COC368318Medicare PIN
E05942Medicare UPIN