Provider Demographics
NPI:1255394722
Name:MIGNOLI, MICHAEL D (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:D
Last Name:MIGNOLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9218 KIMMER DR
Mailing Address - Street 2:SUITE 106
Mailing Address - City:LONETREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-6732
Mailing Address - Country:US
Mailing Address - Phone:303-768-0900
Mailing Address - Fax:303-791-8152
Practice Address - Street 1:9218 KIMMER DR
Practice Address - Street 2:SUITE 106
Practice Address - City:LONETREE
Practice Address - State:CO
Practice Address - Zip Code:80124-6732
Practice Address - Country:US
Practice Address - Phone:303-768-0900
Practice Address - Fax:303-791-8152
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-07
Last Update Date:2011-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO32210207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
COF76405Medicare UPIN
COCC4128Medicare ID - Type UnspecifiedMEDICARE NUMBER
COCOB4567Medicare PIN
COP00765708Medicare PIN