Provider Demographics
NPI:1245498112
Name:LUPICA, MICHELLE LEE (DO)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LEE
Last Name:LUPICA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 W 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:CO
Mailing Address - Zip Code:80759-2641
Mailing Address - Country:US
Mailing Address - Phone:970-848-5405
Mailing Address - Fax:970-848-5475
Practice Address - Street 1:214 SOUTH 4TH STREET
Practice Address - Street 2:
Practice Address - City:KREMMLING
Practice Address - State:CO
Practice Address - Zip Code:80459
Practice Address - Country:US
Practice Address - Phone:970-724-3442
Practice Address - Fax:970-724-9606
Is Sole Proprietor?:No
Enumeration Date:2008-05-28
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO47052207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO91186374Medicaid
COCOA100837Medicare PIN
CO91186374Medicaid